• Adriana L Bertrand, João Batista S Garcia, Erica B Viera, Alcione M Santos, and Romero H Bertrand.
• Federal University of Maranhao, Sao Luis, Maranhao Brazil.
• Pain Physician. 2013 May 1;16(3):E257-66.

BackgroundStudies suggest that the pain response may be evaluated using pupillometry and is influenced by factors such as gender and anxiety.ObjectivesThe aim of this study was to use pupillometry to observe the effects of gender and anxiety on the pain response.Study DesignA randomized, prospective, clinical and interventional study.SettingCenter for Research on Pain at the Federal University of Maranhao, Brazil.MethodsNinety-six patients were divided into groups according to their level of anxiety as indicated by the Beck questionnaire. Under photopic conditions and using retinography, these patients underwent pupillometry while a painful pressure stimulus of 1,500 kPa was applied to the middle phalanx of each patient's right middle finger using a pressure algometer.ResultsThe pupil diameter increased in response to pain in all study participants, regardless of gender and anxiety level; the average pupil diameter was 3.265 ± 0.028 mm before the painful stimulus and 4.31 ± 0.200 mm for the duration of the stimulus (P = 0.0251). There was no significant difference between the genders in the level of anxiety (P = 0.614). Regardless of gender, individuals with moderate to severe anxiety had higher average pupil diameters than individuals exhibiting mild or no anxiety (P = 0.019). Men had a higher average pupil diameter than women (4.53 ± 0.345 mm and 4.48 ± 0.358 mm, respectively); however, this difference was not statistically significant in the presence of moderate to severe anxiety (P = 0.072).LimitationsThe number of men with high anxiety was insufficient to create their own group.ConclusionsThe pupil dilation in response to a painful stimulus was similar in both genders. Additionally, regardless of gender, the average pupil diameter was greater in the presence of moderate to severe anxiety.

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