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By investigating the differences in how men and women experience pain, researchers hope to better understand why more women than men experience chronic painful
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Women are more likely to suffer from chronic pain conditions such as IC, fibromyalgia, migraines, temporomandibular joint disorder (TMJ), and irritable bowel syndrome (IBS).
Women discuss their pain more and more often seek treatment.
Women cope better with pain.
Women are more likely to have their pain under-treated, face a gender bias when it comes to the treatment and management of their pain, and receive less aggressive treatment.
| conditions such as IC. In the lab, scientists report sex-related differences in pain thresholds and tolerance to various stimuli, indicating that women sense a painful stimulus faster and respond to it more quickly than men do. Females also feel these types of experimental pain more intensely.
Healthcare providers and clinical researchers report similar findings from clinical practice:
- Frequency and severity of clinical pain. Women seek treatment for their pain more often and experience more post-operative pain than men do, but remain under-treated when compared to men. Men appear to “hold off” their pain, or ignore it, longer than women.
- Response to treatment. Women may respond better to a newer class of opioids called kappa-opioids (eg, butorphanol, nalbuphine, and pentazocine). Scientists are conducting further research on these products to see if they hold the promise of more effective pain relief for women with severe IC pain. This research could affect how medicines, including IC medicines, are developed and prescribed in the future. For instance, in treating the same illness, men may respond better to one class of medicines and women another.
- Side effects of medicines. Females and males report side effect differences with all types of medicines. According to the Society for Women’s Health Research (SWHR), exactly why medicines affect women and men differently remains unclear. The varying rates at which women and men metabolize drugs are involved, as well as women’s lower body weight, smaller organs, reduced blood flow, and a higher proportion of fat.
- Response to nonpharmacological chronic pain treatments. A recent study, funded by the National Institutes of Health (NIH), is a good example of this gender discrepancy. Researchers used physical therapy (PT) to treat women and men with chronic pelvic pain. Investigators compared pelvic floor directed therapy against full-body Western style massage. While PT won out over massage in both men and women in the study, no women got better with general massage treatment, whereas 45 percent of the men did, and men had higher response scores to both treatments. The reason for this gender difference is not clear. It could be that men and women respond differently to therapeutic touch.
While there are still many unknowns, current research is focusing on two main components that are actually very interconnected: hormones and the brain.
- Sex Hormones. Research points to sex hormones like estrogen and progesterone as critical factors in pain differences. Unlike men’s, women’s hormones fluctuate monthly. Pain studies indicate that female hormones are main culprits in why women seem to experience pain much more intensely than men do.
- Brain Chemistry. In addition, neurotransmitters (brain chemicals such as serotonin, dopamine, and endorphins) allow parts of the brain to communicate with each other and with the rest of the body. These substances could be strong factors in how women and men experience pain, including IC pain.
- Brain Responses. Studies indicate that males and females use different parts of their brains when responding to pain. Also, recent Northwestern University study of IC and chronic pelvic pain syndrome showed that these two conditions light up different regions of the brain. Distinct brain responses in males and females may be one of the reasons why males respond better to mu-opioids while females respond better to kappa-opioids -- they work on different areas of the brain.
- Healthcare providers: Consider these differences when diagnosing illness and prescribing treatment.
- Women: Pay attention to variations in illness and pain tied to the menstrual cycle, and bring your observations to the attention of your physicians.
- Researchers: When studying pain at every level, from molecular to clinical, assess the possible impact of sex and gender.
Research into sex, gender, and pain helps scientists to understand the mechanisms of disease, and to tailor treatments more specifically and effectively. These efforts will help all who suffer from chronic pain to get better relief, narrowing the pain gender gap.
Posted June 18, 2009
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