Women and Pain

Delving into this topic there is so much dismissive and dis-information out there as to why women experience a greater intensity of pain and are more likely to experience chronic pain.

Let's start here:

In August 2017, The New York Times published a guest op-ed by a man named David Roberts who suffered from severe chronic pain for many years before finally finding relief. The piece went viral,when Dan Rather posted it to his Facebook page with the addendum that it could "offer hope" to some pain patients. However, for many of us in the chronic pain community, particularly women, the piece was regarded with frustration.

The first and most prominent source of annoyance regarding this piece was the part when the author discloses his pain to his employer and it is taken with the utmost seriousness. He is immediately offered leave to find treatment, despite the lack of a definitive diagnosis. This stands in stark contrast to the experiences of many (if not most) women, where our pain is often abruptly dismissed as psychological — a physical manifestation of stress, anxiety, or depression.

Because of this women in pain are much more likely than men to receive prescriptions for sedatives, rather than pain medication, for their ailments. One study even showed women who received coronary bypass surgery were only half as likely to be prescribed painkillers, as compared to men who had undergone the same procedure. Women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain in the ER in the United States, while men wait only 49 minutes.

These gender biases in our medical system can have serious and sometimes fatal repercussions. For instance, a study in the New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack. Why? Because the medical concepts of most diseases are based on understandings of male physiology, and women have altogether different symptoms than men when having a heart attack. Not surprising and an older study but to return to the issue of chronic pain, 70% of the people it impacts are women. And yet, 80% of pain studies are still conducted on male mice or human men. One of the few studies to research gender differences in the experience of pain found that women tend to feel it more of the time and more intensely than men. While the exact reasons for this discrepancy haven't been pinpointed yet, biology and hormones are suspected to play a role.1

Article after article on the subject, notes psychological factors and women being “wired differently.” “Conditions such as anxiety and depression, which are reported in greater numbers in women, may exacerbate the effects of painful conditions, even if the pain itself hasn’t actually intensified.” 2 Here we go again, but we should ask ourselves if our pain was actually addressed, would the disparity in the anxiety/depression diagnosis in women exist? Are we being placated?

Additionally these articles go on to point to “the fluctuating nature of female hormones may amplify the body’s perception of pain. For instance, “when estrogen levels are low during the menstrual cycle or after menopause, pain receptor activity is elevated, which in turn causes the body to feel more pain..”2 In reality, the lack of testosterone which has been - more heavily researched- and shown to have pain inhibiting properties may be at play more so then fluctuating estrogen levels.

Despite this, the general scientific consensus on pain perception was that it affected male and female bodies in basically the same way. The problem was, this conclusion wasn’t really based on anything: A male-biased approach has dominated neuroscience research, including pain, typically with no rationale provided.

There is a need for development of more personalized therapies, honed as far as possible for the patient’s individual needs. Practitioners coming up in the fields of medicine need to address the differences and need to address women’s pain, not dismiss it or attribute it to a mental state.

1“Women and pain: Disparities in experience and treatment”, Harvard health publishing, Harvard medical school, Oct 19,2017

2 Rachael Rettner, “Women Feel Pain More Intensely Than Men Do”, My Health News Daily, Scientific American, January 23, 2012