Why Women May Experience Pain Differently Than Men

There are a great many things that men and women experience differently. A newly published study finds that chronic pain is one of them. It turns out that there are important distinctions in how men and women experience pain.

Men, Women, and the Pain Experience

According to the study conducted by researchers at the University of California San Diego School of Medicine, men and women utilize different biological mechanisms for pain relief. This may help explain why women seem more likely than men to experience chronic pain and tend to experience less pain relief from treatment with the most prescribed pain medications—opioids.[1]

This research was designed to evaluate the efficacy of meditation for chronic lower back pain and combined data from two clinical trials involving a total of 98 participants that included both healthy individuals and those diagnosed with chronic lower back pain.

Participants underwent a meditation training program and practiced meditation while receiving either a placebo or a high dose of naloxone, a drug that stops both synthetic and endogenous opioids from working (and is most commonly used to reverse opioid overdoses). Participants were administered a painful but harmless heat stimulus to the back of their leg. Researchers then measured and compared how much pain relief was experienced from meditation when the opioid system was blocked versus when it was fully functional.

The study found:

• Blocking the opioid system with naloxone inhibited meditation-based pain relief in men, suggesting that men rely on endogenous opioids to reduce pain.
• Naloxone increased meditation-based pain relief in women, suggesting that women rely on non-opioid mechanisms to reduce pain.
• In both men and women, those with chronic pain experienced more pain relief from meditation than the healthy participants did.

Endogenous opioids such as endorphins are the body’s natural painkillers. These naturally occurring substances act similarly to prescription opioids like morphine, oxycodone, and hydrocodone, binding to opioid receptors in the brain to reduce the perception of pain. In contrast, pain relief for women appears to utilize alternative, non-opioid pathways, suggesting that women make less use of the body’s internal opioids for pain relief.

Implications for Chronic Pain Treatment

To bottom-line the impact of this new research, there is an important new factor in the treatment of chronic pain—sex. Opioids continue to be the predominant class of medication prescribed for pain management. Yet, there is ample anecdotal evidence that women seem to experience less pain relief from opioid-based treatment than men do, even though they have a greater prevalence of chronic pain. The new study suggests a neurobiological reason why women might not respond as well as men do to opioid-based treatments.

In addition to other pain-relieving qualities, opioids frequently induce feelings of euphoria. This, along with the phenomenon of tolerance (which develops because over time people need higher doses to get the same results), is among the effects that make opioids so potentially addictive. Consistent with the emerging research, women may face a higher risk of addiction to opioids in that they are biologically less responsive to them and therefore need larger doses to achieve pain relief.

Chronic pain treatment has traditionally followed a relatively standardized approach, but if men and women utilize different biological pathways for pain relief, it makes sense they might require more sex-specific approaches to treatment. This study provides clear evidence that sex-based differences in pain processing are real and need to be considered when developing treatments and prescribing medications for pain.

More patient-centered modalities that include sex to individualize treatment could improve patient outcomes and decrease opioid dependence, misuse, and addiction. For women, this includes greater use of options that align with their unique pain pathways, such as anti-inflammatory medications and nerve blockers, as well as complementary and alternative medicine approaches like mindfulness, meditation, acupuncture, yoga, chiropractic, massage, and Qi Gong/Tai Chi.

Copyright 2024 Dan Mager, MSW

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