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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Werner, Mads

CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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Volume 16, Issue 1


Sex moderates the effects of positive and negative affect on clinical pain in patients with knee osteoarthritis

Traci J. Speed
  • Corresponding author
  • Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, United States
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jessica M. Richards
  • The Sandra and Malcolm Berman Brain & Spine Institute, Department of Neurology, Baltimore, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Patrick H. Finan
  • Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Michael T. Smith
  • Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.03.005


Background and aims

Sex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA).


One hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n = 120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time.


Sex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between stable negative affect and KOA-specific pain than women. Sex did not interact with state affect on pain outcomes.


Findings suggest that men may be particularly sensitive to the effects of stable positive affect and negative affect on clinical pain. Future work with larger samples is needed in order to identify potential mechanisms driving the sex-specific effects of affect on pain.


The current study provides novel data that suggesting that the association of positive affect, negative affect, and pain are different in men versus women with KOA. Further understanding of the difference in affective expression between men and women may lead to the development of novel therapeutic interventions and help to identify additional modifiable factors in the prevention and management of pain.

Keywords: Knee osteoarthritis; Sex; Pain; Quantitative sensory testing


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About the article

Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224, United States.

Received: 2016-03-11

Revised: 2017-02-22

Accepted: 2017-03-27

Published Online: 2017-07-01

Published in Print: 2017-07-01

Ethical issues: All participants provided written consent. The study was approved by the Johns Hopkins School of Medicine Institutional Review Board. The study is registered on clinicaltrials.gov as NCT00592449.

Conflict of interest: Authors Speed and Richards have no disclosures or financial or personal conflicts of interest to report. Finan and Smith both serve as consultants for PainCare, LLC. The authors report no other financial or personal conflicts.

Citation Information: Scandinavian Journal of Pain, Volume 16, Issue 1, Pages 66–73, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.03.005.

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