Evaluating Sex Differences in Biomarkers of Chronic Pain Among Active-Duty Personnel: An Exploratory Analysis of a Pragmatic Clinical Trial With a SMART Design

Abstract

Chronic pain affects approximately one-third of active-duty service members (ADSMs), yet effective treatment remains challenging. Salivary cortisol and urinary 8-hydroxy-2ʹ-deoxyguanosine (8-OHdG) are established non-invasive biomarkers of stress and oxidative DNA damage and may provide reliable unbiased indicators of treatment efficacy in chronic pain. However, their associations with pain outcomes and potential sex differences remain unclear. It was hypothesized that interdisciplinary pain treatment would result in decreased levels of stress and oxidative DNA damage biomarkers, as well as decreased pain intensity, and that the magnitude of challenge might vary by sex. Our objective was to compare longitudinal changes in salivary cortisol and urinary 8-OHdG in relation to pain outcomes and sex. A total of 190 ADSMs who referred for chronic pain treatment completed data collection on the Patient-Reported Outcomes Measurement Information System (PROMIS) measures and urine and saliva samples at baseline and post-treatment. Multivariable regression models were used to predict changes in PROMIS scores relative to changes in cortisol and 8-OHdG, while adjusting for baseline levels. Interaction terms between participants’ sex and changes in biomarkers were added to each model. Given the study’s exploratory nature, a significance threshold of p < .10 was used for all analyses. Five statistically significant sex-by-cortisol interactions were identified for pain measures (pain impact, pain interference, physical functioning, sleep impairment, and social functioning), but none for 8-OHdG. Future work is needed to replicate these findings in larger samples. The research protocol was registered in ClinicalTrials.gov (NCT03297905; https://clinicaltrials.gov/study/NCT03297905).

Keywords

biomarkers chronic pain military personnel musculoskeletal pain pain management sex characteristics

Get full access to this article

View all access options for this article.

References

Alexander

S. N.

Green

A. R.

Debner

E. K.

Ramos Freitas

L. E.

Abdelhadi

H. M. K.

Szabo-Pardi

T. A.

Burton

M. D.

(2024). The influence of sex on neuroimmune communication, pain, and physiology. Biology of Sex Differences, 15(1), 82. https://doi.org/10.1186/s13293-024-00660-w

Allen

L. B.

Tsao

J. C. I.

Worthman

C. M.

Zeltzer

L. K.

(2009). Sex differences in the association between cortisol concentrations and laboratory pain responses in healthy children. Gender Medicine, 6(Suppl 2), 193–207. https://doi.org/10.1016/j.genm.2009.03.001

Amtmann

Cook

K. F.

Jensen

M. P.

Chen

W.-H.

Choi

Revicki

Cella

Rothrock

Keefe

Callahan

Lai

J.-S.

(2010). Development of a PROMIS item bank to measure pain interference. Pain, 150(1), 173–182. https://doi.org/10.1016/j.pain.2010.04.025

Balhara

Devi

Balda

Phour

Giri

(2023). Urine; a new promising biological fluid to act as a non-invasive biomarker for different human diseases. URINE, 5, 40–52. https://doi.org/10.1016/j.urine.2023.06.001

Bao

A.-M.

Fischer

D. F.

Y.-H.

Hol

E. M.

Balesar

Unmehopa

U. A.

Zhou

J.-N.

Swaab

D. F.

(2006). A direct androgenic involvement in the expression of human corticotropin-releasing hormone. Molecular Psychiatry, 11(6), 567–576. https://doi.org/10.1038/sj.mp.4001800

Barregard

Møller

Henriksen

Mistry

Koppen

Rossner

Sram

R. J.

Weimann

Poulsen

H. E.

Nataf

Andreoli

Manini

Marczylo

Lam

Evans

M. D.

Kasai

Kawai

Y.-S.

Sakai

Loft

(2013). Human and methodological sources of variability in the measurement of urinary 8-Oxo-7,8-dihydro-2′-deoxyguanosine. Antioxidants and Redox Signaling, 18(18), 2377–2391. https://doi.org/10.1089/ars.2012.4714

Beiner

Lucas

Reichert

Buhai

D.-V.

Jesinghaus

Vock

Drusko

Baumeister

Eich

Friederich

H.-C.

Tesarz

(2023). Stress biomarkers in individuals with fibromyalgia syndrome: A systematic review with meta-analysis. Pain, 164(7), 1416–1427. https://doi.org/10.1097/j.pain.0000000000002857

Bellavance

M.-A.

Rivest

(2014). The HPA – immune axis and the immunomodulatory actions of glucocorticoids in the brain. Frontiers in Immunology, 5, 136. https://doi.org/10.3389/fimmu.2014.00136

Bluth

Roberson

P. N. E.

Girdler

S. S.

(2017). Adolescent sex differences in response to a mindfulness intervention: A call for research. Journal of Child and Family Studies, 26(7), 1900–1914. https://doi.org/10.1007/s10826-017-0696-6

10.

Bourke

C. H.

Harrell

C. S.

Neigh

G. N.

(2012). Stress-induced sex differences: Adaptations mediated by the glucocorticoid receptor. Hormones and Behavior, 62(3), 210–218. https://doi.org/10.1016/j.yhbeh.2012.02.024

11.

Bruehl

Milne

Schildcrout

Shi

Anderson

Shinar

Polkowski

Mishra

Billings

F. T.

(2022). Oxidative stress is associated with characteristic features of the dysfunctional chronic pain phenotype. Pain, 163(4), 786–794. https://doi.org/10.1097/j.pain.0000000000002429

12.

Carlesso

L. C.

Sturgeon

J. A.

Zautra

A. J.

(2016). Exploring the relationship between disease-related pain and cortisol levels in women with osteoarthritis. Osteoarthritis and Cartilage, 24(12), 2048–2054. https://doi.org/10.1016/j.joca.2016.06.018

13.

Carson

H. J.

(2017). Anatomical changes correlated with chronic pain in forensic medicine. Forensic Sciences Research, 2(3), 145–151. https://doi.org/10.1080/20961790.2017.1341364

14.

Cella

Lai

J.-S.

Jensen

S. E.

Christodoulou

Junghaenel

D. U.

Reeve

B. B.

Stone

A. A.

(2016). PROMIS fatigue item bank had clinical validity across diverse chronic conditions. Journal of Clinical Epidemiology, 73, 128–134. https://doi.org/10.1016/j.jclinepi.2015.08.037

15.

Committee on Psychosocial Aspects of Child and Family Health & Task Force on Pain in Infants, Children, and AdolescentsTask Force on Pain in Infants, Children, and Adolescents . (2001). The assessment and management of acute pain in infants, children, and adolescents. Pediatrics, 108(3), 793–797. https://doi.org/10.1542/peds.108.3.793

16.

Davis

K. D.

Aghaeepour

Ahn

A. H.

Angst

M. S.

Borsook

Brenton

Burczynski

M. E.

Crean

Edwards

Gaudilliere

Hergenroeder

G. W.

Iadarola

M. J.

Iyengar

Jiang

Kong

J.-T.

Mackey

Saab

C. Y.

Sang

C. N.

Scholz

Wasan

A. D.

(2020). Discovery and validation of biomarkers to aid the development of safe and effective pain therapeutics: Challenges and opportunities. Nature Reviews Neurology, 16(7), 381–400. https://doi.org/10.1038/s41582-020-0362-2

17.

Deer

T. R.

Caraway

D. L.

Wallace

M. S.

(2014). A definition of refractory pain to help determine suitability for device implantation. Neuromodulation: Technology at the Neural Interface, 17(8), 711–715. https://doi.org/10.1111/ner.12263

18.

Deyo

R. A.

Dworkin

S. F.

Amtmann

Andersson

Borenstein

Carragee

Carrino

Chou

Cook

DeLitto

Goertz

Khalsa

Loeser

Mackey

Panagis

Rainville

Tosteson

Turk

Von Korff

Weiner

D. K.

(2014). Focus article: Report of the NIH task force on research standards for chronic low back pain. European Spine Journal, 23(10), 2028–2045. https://doi.org/10.1007/s00586-014-3540-3

19.

Deyo

R. A.

Ramsey

Buckley

D. I.

Michaels

Kobus

Eckstrom

Forro

Morris

(2016). Performance of a patient reported outcomes measurement information system (PROMIS) short form in older adults with chronic musculoskeletal pain. Pain Medicine, 17(2), 314–324. https://doi.org/10.1093/pm/pnv046

20.

Doody

Bailey

M. E.

(2017). Pain and pain assessment in people with intellectual disability: Issues and challenges in practice. British Journal of Learning Disabilites, 45(3), 157–165. https://doi.org/10.1111/bld.12189

21.

Doorenbos

A. Z.

Haozous

E. A.

Jang

M. K.

Langford

(2019). Sequential multiple assignment randomization trial designs for nursing research. Research in Nursing & Health, 42(6), 429–435. https://doi.org/10.1002/nur.21988

22.

Doorenbos

A. Z.

Kato

(2020). Pragmatic clinical trials: Increasing the rate of translating nursing research into practice. Japan Journal of Nursing Science, 17(3), Article e12350. https://doi.org/10.1111/jjns.12350

23.

Duma

Collins

J. B.

Chou

J. W.

Cidlowski

J. A.

(2010). Sexually dimorphic actions of glucocorticoids provide a link to inflammatory diseases with gender differences in prevalence. Science Signaling, 3(143), ra74. https://doi.org/10.1126/scisignal.2001077

24.

Dunbar

M. S.

Schuler

M. S.

Meadows

S. O.

Engel

C. C.

(2022). Associations between mental and physical health conditions and occupational impairments in the U.S. military. Military Medicine, 187(3–4), e387–e393. https://doi.org/10.1093/milmed/usab021

25.

Dunlavey

C. J.

(2018). Introduction to the hypothalamic-pituitary-adrenal axis: Healthy and dysregulated stress responses, developmental stress and neurodegeneration. Journal of Undergraduate Neuroscience Education, 16(2), R59–R60.

26.

Eldabe

Obara

Panwar

Caraway

(2022). Biomarkers for chronic pain: Significance and summary of recent advances. Pain Research and Management, 2022(3), 1–6. https://doi.org/10.1155/2022/1940906

27.

Evans

K. D.

Douglas

Bruce

Drummond

P. D.

(2008). An exploratory study of changes in salivary cortisol, depression, and pain intensity after treatment for chronic pain. Pain Medicine, 9(6), 752–758. https://doi.org/10.1111/j.1526-4637.2006.00285.x

28.

Fang

X.-X.

Zhai

M.-N.

Zhu

Wang

Zhang

Z.-J.

(2023). Inflammation in pathogenesis of chronic pain: Foe and friend. Molecular Pain, 19, 17448069231178176. https://doi.org/10.1177/17448069231178176

29.

Farkouh

Baumgärtel

Gottardi

Hemetsberger

Czejka

Kautzky-Willer

(2021). Sex-related differences in drugs with anti-inflammatory properties. Journal of Clinical Medicine, 10(7), 1441. https://doi.org/10.3390/jcm10071441

30.

Finkel

Holbrook

N. J.

(2000). Oxidants, oxidative stress and the biology of ageing. Nature, 408(6809), 239–247. https://doi.org/10.1038/35041687

31.

Flynn

Eaton

L. H.

Langford

D. J.

Ieronimakis

McQuinn

Burney

R. O.

Holmes

S. L.

Doorenbos

A. Z.

(2018). A SMART design to determine the optimal treatment of chronic pain among military personnel. Contemporary Clinical Trials, 73, 68–74. https://doi.org/10.1016/j.cct.2018.08.008

32.

Flynn

D. M.

Burke

L. A.

Steffen

A. D.

Ransom

J. C.

Orr

K. P.

McQuinn

H. M.

Snow

T. J.

Doorenbos

A. Z.

(2025a). Estimating minimal important change of the national institutes of health research task force impact score using computer adaptive measures: A secondary analysis of two randomized clinical trials in a military population with chronic pain. BMC Musculoskeletal Disorders, 26(1), 137. https://doi.org/10.1186/s12891-025-08378-5

33.

Flynn

D. M.

Ransom

J. C.

Steffen

A. D.

Orr

K. P.

McQuinn

H. M.

Snow

T. J.

Burke

L. A.

Doorenbos

A. Z.

(2025b). Complementary, integrative, and standard rehabilitative therapies in a military population with chronic predominantly musculoskeletal pain: A pragmatic clinical trial with SMART design. Pain, 166(6), 1343–1353. https://doi.org/10.1097/j.pain.0000000000003462

34.

Gaskin

D. J.

Richard

(2012). The economic costs of pain in the United States. The Journal of Pain, 13(8), 715–724. https://doi.org/10.1016/j.jpain.2012.03.009

35.

Gerdle

Dragioti

Rivano Fischer

Ringqvist

Å.

(2023). Pain intensity and psychological distress show different associations with interference and lack of life control: A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP. Frontiers in Pain Research, 4, 1093002. https://doi.org/10.3389/fpain.2023.1093002

36.

Girard-Tremblay

Auclair

Daigle

Léonard

Whittingstall

Goffaux

(2014). Sex differences in the neural representation of pain unpleasantness. The Journal of Pain, 15(8), 867–877. https://doi.org/10.1016/j.jpain.2014.05.004

37.

Goldberg

D. S.

McGee

S. J.

(2011). Pain as a global public health priority. BMC Public Health, 11(1), 770. https://doi.org/10.1186/1471-2458-11-770

38.

Graille

Wild

Sauvain

J.-J.

Hemmendinger

Guseva Canu

Hopf

N. B.

(2020). Urinary 8-OHdG as a biomarker for oxidative stress: A systematic literature review and meta-analysis. International Journal of Molecular Sciences, 21(11), 3743. https://doi.org/10.3390/ijms21113743

39.

Hahn

E. A.

Beaumont

J. L.

Pilkonis

P. A.

Garcia

S. F.

Magasi

DeWalt

D. A.

Cella

(2016). The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations. Journal of Clinical Epidemiology, 73, 135–141. https://doi.org/10.1016/j.jclinepi.2015.08.034

40.

Hannibal

K. E.

Bishop

M. D.

(2014). Chronic stress, cortisol dysfunction, and pain: A psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical Therapy, 94(12), 1816–1825. https://doi.org/10.2522/ptj.20130597

41.

Hellhammer

D. H.

Wüst

Kudielka

B. M.

(2009). Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology, 34(2), 163–171. https://doi.org/10.1016/j.psyneuen.2008.10.026

42.

Hnatešen

Radoš

Dimitrijević

Budrovac

Omrčen

Pavić

Gusar

Čebohin

Šolić

(2022). Influence of the cognitive and emotional status of patients with chronic pain on treatment success (reduction in pain intensity and adherence to pharmacotherapy): A prospective study. International Journal of Environmental Research and Public Health, 19(23), 15968. https://doi.org/10.3390/ijerph192315968

43.

James

K. A.

Stromin

J. I.

Steenkamp

Combrinck

M. I.

(2023). Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Frontiers in Endocrinology, 14, 1085950. https://doi.org/10.3389/fendo.2023.1085950

44.

Jamison

R. N.

Brown

G. K.

(1991). Validation of hourly pain intensity profiles with chronic pain patients. Pain, 45(2), 123–128. https://doi.org/10.1016/0304-3959(91)90176-X

45.

Kasai

Kawai

(2006). Oxidative DNA damage: Mechanisms and significance in health and disease. Antioxidants and Redox Signaling, 8(5–6), 981–983. https://doi.org/10.1089/ars.2006.8.981

46.

Khera

Rangasamy

(2021). Cognition and pain: A review. Frontiers in Psychology, 12, 673962. https://doi.org/10.3389/fpsyg.2021.673962

47.

Knapik

J. J.

Reynolds

K. L.

Harman

(2004). Soldier load carriage: Historical, physiological, biomechanical, and medical aspects. Military Medicine, 169(1), 45–56. https://doi.org/10.7205/MILMED.169.1.45

48.

Mackey

Aghaeepour

Gaudilliere

Kao

M.-C.

Kaptan

Lannon

Pfyffer

Weber

(2025). Innovations in acute and chronic pain biomarkers: Enhancing diagnosis and personalized therapy. Regional Anesthesia and Pain Medicine, 50(2), 110–120. https://doi.org/10.1136/rapm-2024-106030

49.

Meewisse

M.-L.

Reitsma

J. B.

De Vries

G.-J.

Gersons

B. P. R.

Olff

(2007). Cortisol and post-traumatic stress disorder in adults: Systematic review and meta-analysis. British Journal of Psychiatry, 191(5), 387–392. https://doi.org/10.1192/bjp.bp.106.024877

50.

Mickle

A. M.

Sibille

K. T.

(2024). Deciphering relationships between stress biomarkers and fibromyalgia syndrome with implications relevant to other chronic pain conditions. Pain, 165(1), 243–245. https://doi.org/10.1097/j.pain.0000000000003111

51.

Mouraux

Iannetti

G. D.

(2018). The search for pain biomarkers in the human brain. Brain, 141(12), 3290–3307. https://doi.org/10.1093/brain/awy281

52.

Noguchi

Ikeda

Kanai

Saito

Kondo

Saito

(2024). Association of social isolation and loneliness with chronic low back pain among older adults: A cross-sectional study from Japan gerontological evaluation study (JAGES). Journal of Epidemiology, 34(6), 270–277. https://doi.org/10.2188/jea.JE20230127

53.

Panagiotakopoulos

Neigh

G. N.

(2014). Development of the HPA axis: Where and when do sex differences manifest? Frontiers in Neuroendocrinology, 35(3), 285–302. https://doi.org/10.1016/j.yfrne.2014.03.002

54.

Patel

K. V.

Dansie

E. J.

Turk

D. C.

(2013). Impact of chronic musculoskeletal pain on objectively measured daily physical activity: A review of current findings. Pain Management, 3(6), 467–474. https://doi.org/10.2217/pmt.13.46

55.

Pilkonis

P. A.

Choi

S. W.

Reise

S. P.

Stover

A. M.

Riley

W. T.

Cella

PROMIS Cooperative Group . (2011). Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667

56.

Pincus

Burton

A. K.

Vogel

Field

A. P.

(2002). A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine, 27(5), E109–E120. https://doi.org/10.1097/00007632-200203010-00017

57.

Polli

Van Oosterwijck

Nijs

Marusic

De Wandele

Paul

Meeus

Moorkens

Lambrecht

Ickmans

(2019). Relationship between exercise-induced oxidative stress changes and parasympathetic activity in chronic fatigue syndrome: An observational study in patients and healthy subjects. Clinical Therapeutics, 41(4), 641–655. https://doi.org/10.1016/j.clinthera.2018.12.012

58.

Polomano

R. C.

Galloway

K. T.

Kent

M. L.

Brandon-Edwards

Kwon

K. N.

Morales

Buckenmaier Trip

(2016). Psychometric testing of the defense and veterans pain rating scale (DVPRS): A new pain scale for military population. Pain Medicine, 17(8), 1505–1519. https://doi.org/10.1093/pm/pnw105

59.

Proteggente

A. R.

England

T. G.

Rehman

Rice-Evans

C. A.

Halliwell

(2002). Gender differences in steady-state levels of oxidative damage to DNA in healthy individuals. Free Radical Research, 36(2), 157–162. https://doi.org/10.1080/10715760290006475

60.

Pruessner

J. C.

Kirschbaum

Meinlschmid

Hellhammer

D. H.

(2003). Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology, 28(7), 916–931. https://doi.org/10.1016/S0306-4530(02)00108-7

61.

Reckziegel

Vachon-Presseau

Petre

Schnitzer

T. J.

Baliki

M. N.

Apkarian

A. V.

(2019). Deconstructing biomarkers for chronic pain: Context- and hypothesis-dependent biomarker types in relation to chronic pain. Pain, 160(1), S37–S48. https://doi.org/10.1097/j.pain.0000000000001529

62.

Reif

Adams

R. S.

Ritter

G. A.

Williams

T. V.

Larson

M. J.

(2018). Prevalence of pain diagnoses and burden of pain among active duty soldiers, FY2012. Military Medicine, 183(9–10), e330–e337. https://doi.org/10.1093/milmed/usx200

63.

Rikard

S. M.

Strahan

A. E.

Schmit

K. M.

Guy

G. P.

(2023). Chronic pain among adults—United States, 2019–2021. MMWR. Morbidity and Mortality Weekly Report, 72(15), 379–385. https://doi.org/10.15585/mmwr.mm7215a1

64.

Schalet

B. D.

Hays

R. D.

Jensen

S. E.

Beaumont

J. L.

Fries

J. F.

Cella

(2016). Validity of PROMIS physical function measured in diverse clinical samples. Journal of Clinical Epidemiology, 73, 112–118. https://doi.org/10.1016/j.jclinepi.2015.08.039

65.

Shah

(2018). Salivaomics: The current scenario. Journal of Oral and Maxillofacial Pathology, 22(3), 375–381. https://doi.org/10.4103/jomfp.JOMFP_171_18

66.

Smith

A. F.

Plumb

A. N.

Berardi

Sluka

K. A.

(2025). Sex differences in the transition to chronic pain. Journal of Clinical Investigation, 135(11), Article e191931. https://doi.org/10.1172/JCI191931

67.

Smith

H. J.

Taubman

S. B.

Clark

L. L.

(2020). A burden and prevalence analysis of chronic pain by distinct case definitions among active duty U.S. military service members, 2018. Pain Physician, 23(5), E429–E440.

68.

Strewe

Moser

Buchheim

J.-I.

Gunga

H.-C.

Stahn

Crucian

B. E.

Fiedel

Bauer

Gössmann-Lang

Thieme

Kohlberg

Choukèr

Feuerecker

(2019). Sex differences in stress and immune responses during confinement in Antarctica. Biology of Sex Differences, 10(1), 20. https://doi.org/10.1186/s13293-019-0231-0

69.

Sullivan

M. J. L.

Bishop

S. R.

Pivik

(1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524

70.

Tracey

Woolf

C. J.

Andrews

N. A.

(2019). Composite pain biomarker signatures for objective assessment and effective treatment. Neuron, 101(5), 783–800. https://doi.org/10.1016/j.neuron.2019.02.019

71.

Trevino

C. M.

Geier

Morris

Cronn

deRoon-Cassini

(2022). Relationship between decreased cortisol and development of chronic pain in traumatically injured. Journal of Surgical Research, 270, 286–292. https://doi.org/10.1016/j.jss.2021.08.040

72.

Vachon-Presseau

Roy

Martel

M.-O.

Caron

Marin

M.-F.

Chen

Albouy

Plante

Sullivan

M. J.

Lupien

S. J.

Rainville

(2013). The stress model of chronic pain: Evidence from basal cortisol and hippocampal structure and function in humans. Brain, 136(3), 815–827. https://doi.org/10.1093/brain/aws371

73.

Vamvakopoulos

N. C.

Chrousos

G. P.

(1993). Evidence of direct estrogenic regulation of human corticotropin-releasing hormone gene expression. Potential implications for the sexual dimophism of the stress response and immune/inflammatory reaction. Journal of Clinical Investigation, 92(4), 1896–1902. https://doi.org/10.1172/JCI116782

74.

Choi

Tintle

Ieronimakis

Flynn

D. M.

Ransom

J. C.

Orr

K. P.

McQuinn

H. M.

Snow

T. J.

Doorenbos

A. Z.

(2025). Urine metabolites as indicators of chronic pain and related symptoms in active-duty service members: A secondary data analysis of a pragmatic clinical trial with SMART design. Nursing Research, 74(4), 272–279. https://doi.org/10.1097/NNR.0000000000000827

75.

Huang

(2020). Objective pain assessment: A key for the management of chronic pain. F1000Research, 9, 35. https://doi.org/10.12688/f1000research.20441.1

76.

Yano

Shoji

Baba

Koga

Shiraishi

Orita

Kohno

(2009). Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients. Lung Cancer, 63(1), 111–114. https://doi.org/10.1016/j.lungcan.2008.04.014

77.

Buysse

D. J.

Germain

Moul

D. E.

Stover

Dodds

N. E.

Johnston

K. L.

Pilkonis

P. A.

(2011). Development of short forms from the PROMIS^TM sleep disturbance and sleep-related impairment item banks. Behavioral Sleep Medicine, 10(1), 6–24. https://doi.org/10.1080/15402002.2012.636266

78.

Zhang

Hou

(2021). The role of negative emotions in sex differences in pain sensitivity. NeuroImage, 245, 118685. https://doi.org/10.1016/j.neuroimage.2021.118685

79.

Zimmer

Basler

H.-D.

Vedder

Lautenbacher

(2003). Sex differences in cortisol response to noxious stress. The Clinical Journal of Pain, 19(4), 233–239. https://doi.org/10.1097/00002508-200307000-00006

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.24 MB

0.00 MB