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Is Pain Psychology More Important for Women?

On average, women have more pain than men.  Women experience pain more frequently, and when they do it tends to be more severe and last longer than it does for men [1].  Women are more likely to acquire various chronic pain conditions. For instance, fibromyalgia, migraine, irritable bowel disorder and lupus are all more common in women. In many cases, women may be 200 – 800% times more likely to develop various painful health conditions.  And, some painful conditions are exclusive to women (e.g., vulvodynia and endometriosis).

Women’s pain also tends to be more severe than it is for men [2].  In short, pain is more painful for women. 

WHY Do Women Have More Pain Than Men?

There is no single reason that explains women’s greater pain.  The immune system plays a partial role: women are more likely to acquire inflammatory pain conditions (such as rheumatoid arthritis) and changes in the immune system are noted in other pain conditions, such as complex regional pain syndrome (CRPS) and fibromyalgia. Differences in hormones (sex steroids) are another reason why women have more pain. Hormonal changes—particularly dips in estrogen in pre-menopausal women can flare pain-- and menopause is noted to be associated with greater pain and the development of chronic pain. Given that pain is more common in women it is particularly important to treat it. Pain psychology is an important part of comprehensive pain care. [3] (learn more here)

The Psychology of Pain in Women

Other factors that contribute to women’s greater experience of pain are psychological in nature. For instance, women are more likely to experience anxiety and depression, both of which are risk factors for greater pain severity across chronic pain conditions. Let's not forget that pain is defined as a negative "sensory and emotional experience" (IASP), so there is great opportunity to reduce pain by reducing emotional distress. 

Furthermore, women may be more attuned to pain—meaning we give it more attention and have a harder time disengaging the mind from pain [4]. It makes sense that women would evolve to be more vigilant to pain, given that pain signals danger, the need to escape harm and seek protection.  However, when it comes to chronic pain, this evolutionary hard-wired protective mechanism backfires against women, making it more important to learn ways to counteract it.

The Example of Pain Catastrophizing:  Why it matters more for women

Pain Catastrophizing is a negative cascade of thoughts and emotions related to actual or anticipated pain. Consider Janice, who has daily headaches that tend to begin about an hour after wakening. She may awaken pain-free but soon finds herself in a state of dread about her soon-to-manifest headache.  She finds herself worrying about it, monitoring for the first sign of headache, and feels helpless about it. Janice is catastrophizing her pain. As it turns out, research shows catastrophizing leads to greater pain because it amplifies pain processing in the nervous system.  Research conducted by myself and colleagues suggests that, in women, catastrophizing has been associated with the release of inflammatory factors in the blood [5]. Further, recent research conducted at Stanford University shows that the consequences of catastrophizing appear to be greater for women and at lower levels of catastrophizing than for men.[6] The short story is that pain psychology treatment is more important for women because it offers a critical pathway to reduce suffering and gain control of pain.

5 Pain Psychology Tips for Pain Relief for Women

(1) Learn the relaxation response and dose it like medicine.  If you find yourself distressed about pain or anything else --- work, finances, etc.--- use the relaxation response to counter the stress and negativity and bring yourself to neutral.  Some pathways to the relaxation response include diaphragmatic breathing (slow belly breathing), meditation, mantras, and progressive muscle relaxation.  The relaxation response counteracts the physiological effects of stress and pain. Importantly, it also calms your mind and dampens pain processing in your nervous system.  For best results, use the relaxation response daily or several times daily, just like you would dose a prescription medication. And be sure to use it when you notice yourself focusing on or catastrophizing your pain.

(2) Practice good self-care. As a pain psychologist, I long noticed that women with chronic pain have greater difficulty taking care of themselves because they feel guilty about how pain has impacted their relationships. I and colleagues studied this issue and found that women are more likely to worry about falling short in their interpersonal roles than are men (e.g., partner, wife, mother and friend), and therefore push themselves harder when their body needs care.[7]   While the pattern is understandable, it’s not helpful and can serve to worsen your pain. Remind yourself that you will have more of you to offer others if you are meeting your own needs.  If deep guilt prevents you from caring for yourself, work with a psychologist to address the issue and find a healthy way forward. If you have children, remind yourself that you will be modeling healthy self-care to them.

(3) Begin to notice the connection between your stress and pain. Research shows that women have greater stress responses than men and stress responses make pain more severe. Identify the big and small stress-points in your life and work to reduce them. For example, leaving 10 minutes earlier for appointments may provide the buffer you need to feel relaxed while driving instead of feeling frantic. Every day look for opportunities to reduce your stress.

(4) Adjust your expectations. You may need to adjust your expectations of yourself and your body to a level that is realistic for where you are right now (as opposed to where you would like to be). This can be a tough one; sometimes sadness and grief can emerge in the readjustment process. Work with a pain psychologist or health psychologist if you find yourself stuck with self-expectations that are outdated or are causing you greater stress.

(5) Cultivate Self-Compassion.  At Stanford, we conducted a study of a compassion meditation intervention for people with chronic pain, and most of the participants were women [8]. Compassion cultivation was associated with reduced anger and pain severity at post-treatment.  Self-compassion is particularly important if you are hard on yourself for 'falling short' of self-expectations.  Learning to be gentle with yourself—and cultivating self-compassion—may be the greatest gift of pain relief you can give yourself.

These 5 tips are just a few examples for how pain psychology can help women mitigate some of the greater burdens they experience in regards to chronic pain.

References

[1] Unruh AM. Gender differences in the clinical pain experience. Pain.1996 May-Jun;65(2-3):123-67. Review.

[2] Ibid.

[3] Darnall BD. Sex/gender disparity in pain and pain treatment: Closing the gap and meeting women’s treatment needs. Pain Management 2011; July: 25-27.

[4] Unruh AM, Ritchie J, Merskey H. Does gender affect appraisal of pain and pain coping strategies? Clin J Pain. 1999 Mar;15(1):31-40.

[5] Darnall BD, Aickin M, Zwickey H, Pilot study of inflammatory responses following a negative imaginal focus in persons with chronic pain: analysis by sex/gender. Gender Medicine. 2010 Jun;7(3):247-60. 

[6] Sharifzadeh Y, Darnall BD, Kao MC, Mackey SC. Opioid prescription is predicted by novel sub-clinical range of pain catastrophizing: Discovery from resampling nonparametric modeling. Pain Medicine. 2015; 16(3):586.

[7] Darnall BD, Wilson AC, Pierce DA. CARE Scale: Development and validation of a measure assessing the impact of relationships on self-care in chronic pain. J Pain. 2012; 13 (4), S1: S19.

[8] Chapin HL, Darnall BD, Seppala E, Hah JM, Doty J, Mackey SC. Compassion meditation training for people living with chronic pain and their significant others:  A pilot study and mixed-methods analysis. J Compassionate Healthcare. 2014; 1:4. 

About the Author

Beth Darnall, Ph.D.

Beth Darnall, Ph.D., is the author of Less Pain, Fewer Pills…. She is a pain psychologist, pain researcher, and clinical associate professor at Stanford University.

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