“If someone’s reporting that they’re in pain, they’re probably going to be given medication, which might reduce any subsequently measured pain score,” said Butte. To get pain estimates that weren’t as confounded by subsequent pain-relief medications or procedures, his group analyzed only the first pain-intensity score reported by a patient per encounter with a hospital-associated health professional.

The search identified 47 separate diagnostic categories for which there were more than 40 pain reports for each gender. The sample included more than 11,000 individual adult patients, of which 56 percent were women and 51 percent of them white. The researchers were able to further analyze these 47 categories by condensing them into 16 disease clusters: “musculoskeletal and connective tissue” (in which the biggest gender differences in reported pain intensity were observed), “circulatory” and so forth.

“We saw higher pain scores for female patients practically across the board,” said Butte. Those reported differences were not only statistically significant, but also clinically significant. “In many cases, the reported difference approached a full point on the 1-to-10 scale. How big is that? A pain-score improvement of one point is what clinical researchers view as indicating that a pain medication is working.”

While the overall results tended to confirm previous clinical findings — for example, that female fibromyalgia or migraine patients report more pain than their male counterparts — the search also unearthed previously unreported gender differences in pain intensity for particular diseases, for example acute sinusitis and “cervical spine disorders,” more commonly known as neck pain.

The study’s results come with a few caveats. First, the investigators made the assumption that patients’ pain hadn’t already been treated—for example, that they hadn’t already self-medicated with over-the-counter painkillers — by the time they showed up in the emergency room, doctor’s office or neighborhood health clinic (or, equivalently, that the men and women were equally likely to have done so).

Other possible confounders include the setting in which pain was reported, Butte said. “Will an 18-year-old male report the same pain intensity with or without his mom present, or in the presence of a male vs. a female nurse? We can’t be sure.” But the sheer size of the study probably washes these concerns out at least to some extent, he said.

The third caveat is perhaps the most controversial. “It’s still not clear if women actually feel more pain than men do,” said Butte. “But they’re certainly reporting more pain than men do. We don’t know why. But it’s not just a few diseases here and there, it’s a bunch of them — in fact, it may well turn out to be all of them. No matter what the disease, women appear to report more-intense levels of pain than men do.”

To get to the bottom of this, Butte’s team plans to search EMRs to see if they can find some objective measurement — an already commonly measured blood-test variable, for instance — that correlates highly with reported pain. “We want to find a biomarker for pain,” he said.

Painting: The Scream by Evard Munch, Wikipedia

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