Differences in Pain, Psychological Symptoms, and Gender Distribution among Patients with Left- vs Right-Sided Chronic Spinal Pain

OBJECTIVE: To determine pain levels, function, and psychological symptoms in relation to predominant sidedness of pain (right or left) and gender in patients being treated for chronic spinal pain. DESIGN: Prospective cohort study. PATIENTS: Patients with chronic neck or low back pain undergoing a nerve block procedure in a specialty pain medicine clinic. INTERVENTIONS/OUTCOMES: Patients completed the Hospital Anxiety and Depression Scale and the Brief Pain Inventory just prior to the procedure. Pain history and demographic variables were collected from a chart review. Chi-square, Pearson correlations, and multivariate statistics were used to characterize the relationships between side of pain, gender, pain levels, pain interference, and psychological symptoms. RESULTS: Among 519 subjects, men with left-sided pain (N = 98) were found to have significantly greater depression and anxiety symptoms and worse pain-related quality of life (P < 0.01), despite having similar pain levels as men with right-sided pain (N = 91) or women with left- or right-sided pain (N = 289). In men, psychological symptoms had a significantly greater correlation with pain levels than in women (P < 0.01). CONCLUSION: In this sample, men with left-sided spinal pain report worse quality of life and more psychological symptoms than women. These data provide clinical evidence corroborating basic neuroscience findings indicating that the right cerebral hemisphere is preferentially involved in the processing of pain and negative affect. These data suggest that men appear more right hemisphere dominant in pain and affect processing. These findings have implications for multidisciplinary assessment and treatment planning in men.