The neurobiological underpinnings of gender differences in pain perception, and how these differences may be modified by age, are incompletely understood, placing patients at risk of suboptimal
pain management. Using functional magnetic resonance imaging, we examined brain responses in the descending
pain modulatory system (
DPMS, specifically, dorsolateral prefrontal cortex, anterior cingulate cortex, insula, hypothalamus, amygdala, and periaqueductal gray, during an evoked
pain task. We investigated the interaction of age and gender in our sample of healthy adults (27 females, 32 males, 30-86 years) on
DPMS response. In a perceptually matched thermal
pain paradigm, we investigated
pain unpleasantness and neural responses for 3 heat
pain percepts: just noticeable
pain, weak
pain, and moderate
pain (MP). Females reported just noticeable
pain at a lower temperature, but reported less unpleasantness at weak
pain and MP percepts, compared to males. There was a significant age-by-gender interaction during moderate
pain in the right anterior cingulate cortex and bilateral insula, such that, males had a stronger positive relationship between
DPMS response and age compared to females in these regions. Our results indicate that differences in
DPMS responses may explain some gender differences in pain perception and that this effect may change across the adult lifespan. PERSPECTIVE: Gender differences in
pain have been well-documented but the brain mechanisms for these differences are still unclear. This article describes potential differences in brain functioning during different levels of
pain that could explain differences in
pain responses between men and women across the adult lifespan.