Mark Borigini M.D.

Overcoming Pain

Why Women Experience More Chronic Pain Than Men

“And she aches just like a woman”

Posted Aug 15, 2010

Perhaps Mr. Dylan's lyrics have some relativity almost fifty years since they were put to paper.

There is most definitely a difference in the experience of pain in women compared to men, according to a recent research update presented at the American Psychological Association annual meeting last week.

It appears that women experience chronic pain more frequently, with more intensity and of greater duration compared to men. Women are also more likely to confront simultaneously a variety of painful afflictions that can impact the psychological homeostasis, leading to exponential increases in stress and disability claims.

Chronic pain, defined as pain that lasts six months or longer without relief from treatment (whether it be pharmacologic therapy, physical therapy, or psychological counseling), can be associated with conditions such as fibromyalgia, irritable bowel syndrome, migraine headache and rheumatoid arthritis-all of which are, interestingly, generally more prevalent in women.

There has been quite a bit of research into the role hormones play in these various illnesses. Rheumatoid arthritis is more prevalent among women, implying a significant role for estrogen. And it is well known that estrogen has a role in many cases of migraine headache. Finally, while the incidence of painful conditions rises slowly or remains stable during male adolescence, the incidence of painful conditions have been shown to have an impressive spike upwards for female adolescents.

The perception of pain appears to vary with hormone changes, as shown by studies that demonstrate temperomandibular jaw pain is most intense during the menstrual and pre-menstrual portions of the female cycle.

Of course, this was an American Psychological Association meeting, and thus the role of social and psychological factors in chronic pain cannot be ignored, particularly when considering the protean factors involved with the differential response men and women have to analgesic medications; medications may not substitute for attention to the emotional aspects of chronic pain in the female patient. In general, men tend to focus on the physical sensations experienced. Women may actually experience a greater degree of pain due to the negative emotions associated with pain (see my recent blog, "Dirty Talkin'").

Chronic pain needs to be presented to the chronic pain patient---particularly, in light of the above, the female patient---as a thing that is to be mastered. It is to be mastered through coping strategies that can alter the negativity of the emotional accompaniment to chronic pain, and allow women to assume an active role in being their own health care provider through behavioral changes that can further impact physical and psychological health.

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