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Abstract
The goals of this study were to compare whether emergency department (ED) patients' pain intensity (PI) is measured differently by male and female nurses and to determine whether PI, heart rate (HR), and respiratory rate (RR) were used to prioritize patient urgency differently by male and female nurses. The associations between patients' PI|HR|RR and the Emergency Severity Index (ESI) scores they were assigned by attending nurses were analyzed using a national database of electronic medical records of US Veterans Affairs ED patients from 2008 to 2012. A total of 129,991 patients presenting for emergency care (Mage = 59.5, 92% males) and their triage nurses (n = 774, Mage = 47.5, 18% males) were analyzed, resulting in a total of 359,642 patient-provider interactions. Patients' PI did not differ by the nurse's gender; however a cross-classified mixed-effects model showed that nurse gender influenced how PI and RR measurements informed the ESI levels that male patients received. Higher PI levels were associated with more urgent (higher priority) ESI levels by female nurses, yet less urgent ESI levels by male nurses. In contrast, male patients with high RR received more urgent ESI levels by male nurses, whereas the nurse gender did not influence ESI assignments for female patients. These findings show that ED patients receive disparate treatment based on inherent characteristics of their triage nurses, and more standardized (eg, automated) protocols that can account for implicit social factors on health care practice for reliably assessing and prioritizing ED patients may be currently warranted.
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The Curse of Curves: Sex Differences in the Associations Between Body Shape and Pain Expression. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2015; 26:235-54. [PMID: 26047668 DOI: 10.1007/s12110-015-9232-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examines the associations between objective and subjective measurements and impressions of body shape and cold pressor pain reporting in healthy adults. On the basis of sexual selection theory (SST), we hypothesized that body characteristics that are universally preferred by the opposite sex-specifically, lower waist-to-hip ratios (WHR) in women and higher shoulder-to-hip ratios (SHR) in men-and characteristics (e.g., proportion of body fat in women) that infer attractiveness differently across cultures will correspond to higher experimental pain reporting in women and lower pain reporting in males. A convenience sample of young adults (n = 96, 58 females, 18-24 years; mean age = 19.4) was measured for body mass index (BMI), WHR, SHR, and subjective body impressions (SBI), along with cold pressor pain reporting. The findings showed that BMI was positively associated with WHR and less-positive SBI in both sexes. Consistent with SST, however, only BMI and WHR predicted variability in pain expression in women, whereas only SHR predicted variability in men. Subjective body impressions were positively associated with SHR among males and unrelated to WHR among females, yet only females showed a positive association between SBI and higher pain reporting. The findings suggest that sexually selected physical characteristics (WHR and SHR) and culturally influenced somatic (BMI) and psychological (SBI) indicators of attractiveness correspond with variability in pain reporting, potentially reflecting the general tendency for people to express clusters of sexually selected and culturally influenced traits that may include differential pain perception.
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Vigil JM, DiDomenico J, Strenth C, Coulombe P, Kruger E, Mueller AA, Guevara Beltran D, Adams I. Experimenter Effects on Pain Reporting in Women Vary across the Menstrual Cycle. Int J Endocrinol 2015; 2015:520719. [PMID: 25892990 PMCID: PMC4393943 DOI: 10.1155/2015/520719] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/15/2015] [Indexed: 01/21/2023] Open
Abstract
Background. Separate lines of research have shown that menstrual cycling and contextual factors such as the gender of research personnel influence experimental pain reporting. Objectives. This study examines how brief, procedural interactions with female and male experimenters can affect experimentally reported pain (cold pressor task, CPT) across the menstrual cycle. Methods. Based on the menstrual calendars 94 naturally cycling women and 38 women using hormonal contraceptives (M age = 19.83, SD = 3.09) were assigned to low and high fertility groups. This assignment was based on estimates of their probability of conception given their current cycle day. Experimenters (12 males, 7 females) engaged in minimal procedural interactions with participants before the CPT was performed in solitude. Results. Naturally cycling women in the high fertility group showed significantly higher pain tolerance (81 sec, d = .79) following interactions with a male but not a female experimenter. Differences were not found for women in the low fertility or contraceptive groups. Discussion. The findings illustrate that menstrual functioning moderates the effect that experimenter gender has on pain reporting in women. Conclusion. These findings have implications for standardizing pain measurement protocols and understanding how basic biopsychosocial mechanisms (e.g., person-perception systems) can modulate pain experiences.
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Affiliation(s)
- Jacob M. Vigil
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
- *Jacob M. Vigil:
| | - Jared DiDomenico
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
| | - Chance Strenth
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
| | - Patrick Coulombe
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
| | - Eric Kruger
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
| | - Andrea A. Mueller
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
| | - Diego Guevara Beltran
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
| | - Ian Adams
- Department of Psychology, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-1161, USA
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Vigil JM, Strenth C. No pain, no social gains: A social-signaling perspective of human pain behaviors. World J Anesthesiol 2014; 3:18-30. [DOI: 10.5313/wja.v3.i1.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/14/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
In this review article, we describe a social-signaling perspective of human pain and pain empathizing behaviors which is based on the premise that pain percepts evolved to serve both intrapersonal as well as interpersonal, communicative functions. This perspective offers a generative framework for understanding the natural origin and proximate expression of felt pain and pain empathizing behaviors. The basic thesis is that humans evolved sensory-behavioral heuristics for perceiving and inhibiting exogenous and endogenous pain sensations as part of more general expressive styles characterized by the demonstration of vulnerability gestures (i.e., trustworthiness cues) versus empowerment gestures (i.e., capacity cues), and these styles ultimately facilitate broader self-protection and social novelty-seeking life-history behavior strategies, respectively. We review the extant literature on how social contextual factors (e.g., audience characteristics) and how structural and functional components of individual’s social network appear to influence the expression of pain behaviors in ways that support basic predictions from the social-signaling perspective. We also show how the perspective can be used to interpret conventional findings of sex differences in pain percepts and pain empathizing behaviors and for predicting how the situational context and individual’s peer networks modulate these differences in vitro and in vitro. We conclude the article by describing how pain researchers may better understand how varying levels and divergent directions of changes in affect tend to co-occur with systematic changes in internal vs external pain sensitivities, and thus why, from an evolutionary perspective, pain may occur in the presence and absence of physical tissue damage.
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Vigil JM, Strenth C, Trujillo T, Gangestad SW. Fluctuating experimental pain sensitivities across the menstrual cycle are contingent on women's romantic relationship status. PLoS One 2014; 9:e91993. [PMID: 24647612 PMCID: PMC3960151 DOI: 10.1371/journal.pone.0091993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/16/2014] [Indexed: 01/31/2023] Open
Abstract
We explored the social-signaling hypothesis that variability in exogenous pain sensitivities across the menstrual cycle is moderated by women's current romantic relationship status and hence the availability of a solicitous social partner for expressing pain behaviors in regular, isochronal ways. In two studies, we used the menstrual calendars of healthy women to provide a detailed approximation of the women's probability of conception based on their current cycle-day, along with relationship status, and cold pressor pain and ischemic pain sensitivities, respectively. In the first study (n = 135; 18-46 yrs., Mage = 23 yrs., 50% natural cycling), we found that naturally-cycling, pair-bonded women showed a positive correlation between the probability of conception and ischemic pain intensity (r = .45), associations not found for single women or hormonal contraceptive-users. A second study (n = 107; 19-29 yrs., Mage = 20 yrs., 56% natural cycling) showed a similar association between greater conception risk and higher cold-pressor pain intensity in naturally-cycling, pair-bonded women only (r = .63). The findings show that variability in exogenous pain sensitivities across different fertility phases of the menstrual cycle is contingent on basic elements of women's social environment and inversely correspond to variability in naturally occurring, perimenstrual symptoms. These findings have wide-ranging implications for: a) standardizing pain measurement protocols; b) understanding basic biopsychosocial pain-related processes; c) addressing clinical pain experiences in women; and d) understanding how pain influences, and is influenced by, social relationships.
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Affiliation(s)
- Jacob M. Vigil
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Chance Strenth
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Tiffany Trujillo
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Steven W. Gangestad
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
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Vigil JM, Rowell LN, Chouteau S, Chavez A, Jaramillo E, Neal M, Waid D. Sex differences in how social networks and relationship quality influence experimental pain sensitivity. PLoS One 2013; 8:e78663. [PMID: 24223836 PMCID: PMC3818490 DOI: 10.1371/journal.pone.0078663] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/15/2013] [Indexed: 12/26/2022] Open
Abstract
This is the first study to examine how both structural and functional components of individuals' social networks may moderate the association between biological sex and experimental pain sensitivity. One hundred and fifty-two healthy adults (mean age = 22yrs., 53% males) were measured for cold pressor task (CPT) pain sensitivity (i.e., intensity ratings) and core aspects of social networks (e.g., proportion of friends vs. family, affection, affirmation, and aid). Results showed consistent sex differences in how social network structures and intimate relationship functioning modulated pain sensitivity. Females showed higher pain sensitivity when their social networks consisted of a higher proportion of intimate types of relationship partners (e.g., kin vs. non kin), when they had known their network partners for a longer period of time, and when they reported higher levels of logistical support from their significant other (e.g., romantic partner). Conversely, males showed distinct patterns in the opposite direction, including an association between higher levels of logistical support from one's significant other and lower CPT pain intensity. These findings show for the first time that the direction of sex differences in exogenous pain sensitivity is likely dependent on fundamental components of the individual's social environment. The utility of a social-signaling perspective of pain behaviors for examining, comparing, and interpreting individual and group differences in experimental and clinical pain reports is discussed.
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Affiliation(s)
- Jacob M. Vigil
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
- * E-mail:
| | - Lauren N. Rowell
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Simone Chouteau
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Alexandre Chavez
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Elisa Jaramillo
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Michael Neal
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - David Waid
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
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Vigil JM. Political leanings vary with facial expression processing and psychosocial functioning. GROUP PROCESSES & INTERGROUP RELATIONS 2010. [DOI: 10.1177/1368430209356930] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Conservative, Republican sympathizers show heightened threat reactivity, but greater felt happiness than liberal, Democrat sympathizers. Recent evolutionary models interpret these findings in the context of broader perceptual and expressive proclivities for advertising cues of competency (Republicans) and trustworthiness (Democrats) to others, and in ways that facilitate the formation of distinct social networks, in coordination with individuals’ life histories. Consistent with this perspective, I found that Republican sympathizers were more likely to report larger social networks and interpret ambiguous facial stimuli as expressing more threatening emotions as compared to Democrat sympathizers, who also reported greater emotional distress, relationship dissatisfaction, and experiential hardships. The findings are discussed in the context of proximate and ultimate explanations of social cognition, relationship formation, and societal cohesion.
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