Journal of Behavioral Medicine

, Volume 33, Issue 3, pp 200–208 | Cite as

Suppression of pain-related thoughts and feelings during pain-induction: sex differences in delayed pain responses

  • John W. Burns
  • Erin Elfant
  • Phillip J. Quartana


Women tend to report greater acute and chronic pain intensity than men, and various mechanisms have been proposed to account for these sex differences. Suppression has been related to amplified pain intensity, and thus we examined whether sex differences in the use of suppression partly explained the discrepancy between men and women on pain report. Participants (N = 222; women: 55%) underwent a cold pressor, during which half the sample was randomly assigned to suppress pain-related thoughts and feelings and the other half was not. A 2-min recovery period followed the cold pressor. Ten min later, all participants were exposed to another physical stimulus (a massage device). Significant condition × Sex interactions were found for pain intensity, sensory ratings from the McGill Pain Questionnaire and unpleasantness ratings for the massage device, such that: (a) men in the No Suppression condition reported lower pain and unpleasantness than women in the same condition; (b) men in Suppression condition reported greater pain and unpleasantness then men in No Suppression condition, but equivalent pain and unpleasantness to women in No Suppression condition; (c) differences between men and women on pain in No Suppression condition were partly mediated by women’s report of greater spontaneous use of avoidance/suppression during the cold pressor. Results using an “addition” paradigm (i.e., manipulating use of suppression) and a “take away” (i.e., mediation) paradigm converge to suggest that women spontaneously use suppression to regulate pain more than men, and that the differential use of suppression partly explains the tendency for women to report greater pain intensity than men.


Suppression Ironic effects Pain intensity Sex differences 



This work was partly supported by grant R01-MH071260 from the National Institutes of Health.


  1. Blumberg, S. J. (2000). The white bear suppression inventory: Revisiting its factor structure. Personality and Individual Differences, 29, 943–950.CrossRefGoogle Scholar
  2. Burns, J. W. (2006). The role of attentional strategies in moderating links between acute pain induction and subsequent emotional stress: Evidence for symptom specific reactivity among chronic pain patients versus healthy nonpatients. Emotion, 6, 180–192.CrossRefPubMedGoogle Scholar
  3. Burns, J. W., Quartana, P. J., & Bruehl, S. (2008). Anger inhibition and pain: Conceptualizations, evidence and new directions (invited). Journal of Behavioral Medicine, 31, 259–279.CrossRefPubMedGoogle Scholar
  4. Cioffi, D., & Holloway, J. (1993). Delayed costs of suppressed pain. Journal of Personality and Social Psychology, 64, 274–282.CrossRefPubMedGoogle Scholar
  5. Edwards, R. R., Fillingim, R. B., Maixner, W., Sigurdsson, A., & Haythornthwaite, J. (2004). Catastrophizing predicts changes in thermal pain responses after resolution of acute dental pain. The Journal of Pain, 5, 164–170.CrossRefPubMedGoogle Scholar
  6. Elfant, E., Burns, J. W., & Zeichner, A. (2008). Repressive coping style and suppression of pain-related thoughts: Effects on responses to acute pain induction. Cognition & Emotion, 22, 671–696.CrossRefGoogle Scholar
  7. Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L. (2009). Sex, gender, and pain: A review of recent clinical and experimental findings. Journal of Pain, 10, 447–485.PubMedGoogle Scholar
  8. Goodin, B. R., McGuire, L., Allshouse, M., Stapleton, L., Haythornthwaite, J. A., Burns, N., et al. (2009). Associations between catastrophizing and endogenous pain-inhibitory processes: Sex differences. Journal of Pain, 10, 180–190.CrossRefPubMedGoogle Scholar
  9. Keefe, F. J., Lefebvre, J. C., Egert, J. R., Affleck, G., Sullivan, M. J., & Caldwell, D. S. (2000). The relationship of gender to pain, pain behavior and disability in osteoarthritis patients: The role of catastrophizing. Pain, 87, 325–334.CrossRefPubMedGoogle Scholar
  10. Keogh, E., & Denford, S. (2009). Sex differences in perceptions of pain coping strategy usage. European Journal of Pain, 13, 629–634.CrossRefPubMedGoogle Scholar
  11. Keogh, E., Hatton, K., & Ellery, D. (2000). Avoidance versus focused attention and the perception of pain: Differential effects for men and women. Pain, 85, 225–230.CrossRefPubMedGoogle Scholar
  12. Masedo, A. I., & Esteve, M. R. (2007). Effects of suppression, acceptance, and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45, 199–209.CrossRefPubMedGoogle Scholar
  13. Melzack, R. (1987). The short-form of the McGill Pain Questionnaire. Pain, 30, 191–197.CrossRefPubMedGoogle Scholar
  14. Ninot, G., Fortes, M., Poulain, M., Brun, A., Desplan, J., Prefaut, C., et al. (2006). Gender differences in coping strategies among patients enrolled in an inpatient rehabilitation program. Heart and Lung, 35, 130–136.CrossRefPubMedGoogle Scholar
  15. Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology, 77, 1061–1072.CrossRefPubMedGoogle Scholar
  16. Peterson, B. D., Newton, C. R., Rosen, K. H., & Skaggs, G. E. (2006). Gender differences in how men and women who are referred for IVF cope with infertility stress. Human Reproduction, 21, 2443–2449.CrossRefPubMedGoogle Scholar
  17. Robichaud, M., Dugas, M. J., & Conway, M. (2003). Gender differences in worry and associated cognitive-behavioral variables. Journal of Anxiety Disorders, 17, 501–516.CrossRefPubMedGoogle Scholar
  18. Robinson, M. E., Riley, J. L., Myers, C. D., Papas, R. K., Wise, E. A., Waxenberg, L. B., et al. (2001). Gender role expectations of pain: Relationship to sex differences in pain. Journal of Pain, 2, 251–257.PubMedGoogle Scholar
  19. Sullivan, M. J. L., Rouse, D., Bishop, S., & Johnston, S. (1997). Thought suppression, atastrophization, and pain. Cognitive Therapy and Research, 21, 555–568.CrossRefGoogle Scholar
  20. Thorn, B. E., Clements, K. L., Ward, L. C., Dixon, K. E., Kersh, B. C., Boothby, J. L., et al. (2004). Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain. Clinical Journal of Pain, 20, 275–282.CrossRefPubMedGoogle Scholar
  21. Wang, C., Cheng, Y., Liu, T., Li, Q., Fillingim, R. B., Wallace, M. R., et al. (2008). A computational model for sex-specific genetic architecture of complex traits in humans: Implications for mapping pain sensitivity. Molecular Pain, 16, 13–23.CrossRefGoogle Scholar
  22. Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 34–52.CrossRefPubMedGoogle Scholar
  23. Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. Annual Review of Psychology, 51, 59–91.CrossRefPubMedGoogle Scholar
  24. Wiesenfeld-Hallin, Z. (2005). Sex differences in pain perception. Gender Medicine, 2, 137–145.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • John W. Burns
    • 1
  • Erin Elfant
    • 2
  • Phillip J. Quartana
    • 3
  1. 1.Department of Behavioral SciencesRush UniversityChicagoUSA
  2. 2.New Dawn Recovery CentersSausalitoUSA
  3. 3.Department of Psychiatry & Behavioral Sciences, Center for Mind-Body ResearchJohns Hopkins University School of MedicineBaltimoreUSA

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