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Cognitive/affective factors are important determinants of pain responses and likely contribute to sex differences in pain.289,335 The cognitive and affective mechanisms that have been investigated most widely in the context of sex and gender differences include coping processes, catastrophizing, and affective factors (eg, anxiety, depression). The following sections discuss the evidence regarding sex differences in the associations among psychological factors and pain report. A study of third- and fifth-grade children in Finland found that 32% reported a weekly musculoskeletal pain with significantly more girls reporting pain in chest (7%, 4%) and in the upper back (8%, 5%) compared with boys.278 Sex-related differences were not found for the lower back and neck pain.
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