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9 Articles in Volume 15, Issue #3
Abuse-Deterrent Formulations
Ask The Expert: False-Positive Screen for Benzodiazepines
Clinical Diagnosis of Centralized Pain in the Age of ICD 10
Editor's Memo: The WHO Pain Treatment 3-Step Ladder
Letters to the Editor: Hormone Dosing, Adhesive Arachnoiditis
Pain in Women
PROMIS Pain-Related Measures: An Overview
Selective Interventional Spinal Techniques: Injections and Ablations
Transcranial Direct Current Stimulation (tDCS): What Pain Practitioners Need to Know

Pain in Women

Highlights from a TwitterChat Hosted by the American Society of Anesthesiologists

On January 29, 2015, the American Society of Anesthesiologists (ASA) hosted a TwitterChat on how pain affects women and how it can be treated. Anita Gupta, DO, PharmD, answered on behalf of ASA, Roger B. Fillingim, PhD, answered on behalf of the American Pain Society, Beth Darnall, PhD, answered on behalf of the Stanford Systems Neuroscience and Pain Lab, and Sean Mackey, MD, PhD, represented both the Stanford Systems Neuroscience and Pain Lab and the American Academy of Pain Medicine in his responses. The following is a summary of the top questions and answers from the chat.

Q: Do men and women deal with pain differently? How and why?

ASALifeline: Yes. Men and women feel pain differently. This could be behavioral. Even under the same amount of pain, women push through the pain. Men seek help and rest more readily, whereas women tend to think the worst and accept the pain. Women use a broader range of coping skills, seeking social support and emotion-focused coping, but they also are more prone to catastrophizing.

Q: Why are women more likely than men to endure their pain?

ASALifeline: It comes down to culturally learned behaviors. Women hold out from seeking help and tend to imagine worse outcomes. Thus, with more advanced disease, the outcomes tend to be worse for women. Also, women are less likely to be offered treatments than men. There was a great article in the Wall Street Journal that highlights this issue: Why Women are Living in the Discomfort Zone.1

Q: When a woman comes to you for help, how long has she typically been dealing with pain? What finally gets her to come to see you?

ASALifeline: This varies, but what finally makes them come in is the failure of various providers to control their pain.

AmericanPainSociety: There is some evidence that women and men have different goals from pain treatment. Care will be sought until goals are met.

ASALifeline: Agreed. Most women go to many other specialists before finding a pain specialist to provide treatment.

StanfordPain: At the Stanford Pain Management Center, women typically have had pain for several years when they come in for their first visit. Women will seek care when the pain is significantly impacting their life and they’re not able to self manage.


Q: How do you define chronic pain?

AmericanPainSociety: Pain that has outlived its usefulness.

ASALifeline: Chronic pain is constant pain for more than 3 months that has no relief with treatments and that interferes with activities of daily life.

StanfordPain: Chronic pain is pain that lasts beyond the expected time of tissue healing.

Q: Are women’s headaches different, more severe? Are women more or less likely to have tension headaches or migraines?

ASALifeline: Everything changes at puberty. Although the risk is the same until puberty, after puberty women are 2 to 3 times more likely than men to have migraines, and they also are more likely to have tension headaches. Men are more likely to have cluster headaches. Sex hormones can affect headaches. 

AmericanPainSociety: Then, after menopause, migraine prevalence in men and women equals out again.

Q: Why do women report more pain after surgery?

AmericanPainSociety: This could be due to more inflammation, worse pain control, increased pain sensitivity, or a higher willingness to report pain.

Q: Why are women less likely to get offered treatments than men?

AmericanPainSociety: One concern is gender bias in pain treatment, with women more likely to have their pain discounted.

ASALifeline: Their pain is more likely to be overlooked, and they are less likely to find the appropriate specialist for treatment.

Q. Are women more or less likely than men to use and become addicted to painkillers?

ASALifeline: Women are more likely to use painkillers and to use them at high doses and for longer periods of time. As mentioned, women have a lower threshold for pain and feel the pain more intensely and for longer periods. Addiction studies show women become addicted over a shorter period and suffer more serious medical complications. In the last decade, there has been a 5-fold increase in women who have overdosed compared with a 3.6-fold increase in men.

Q: How much do you think everyday demands on women—stress, diet, lack of exercise or sleep—are responsible for their pain?

AmericanPainSociety: Women may tolerate their pain due to family/social/job demands. Women are at more risk for sleep problems and stress.

ASALifeline: Pain has a multifactorial pathology. Women can feel better if they can gain better control in all aspects of their lives.

StanfordPain: Your thoughts, emotions, and daily choices have a big impact on your pain experience! You can use pain psychology skills and techniques to better manage your daily pain. Improving your sleep quality can decrease pain and also bolster mood.

Q: Are Americans in general, and women in particular, suffering from pain more today than in the past?

AmericanPainSociety: The prevalence of chronic pain is increasing, partly due to the increasing age and obesity of the population.

ASALifeline: Chronic pain negatively affects older people at increased rates. As the population ages, more Americans, and more women, are in pain than ever before.

AmericanPainSociety: Age is a factor, but studies show increase pain prevalence even after controlling for age.

StanfordPain: Yes, in addition to an aging population, improvements in the treatments of cancer may result in survival but at the cost of chronic pain. Also, we are improving care in major trauma and wartime, but this is resulting in patients living with chronic pain. Finally, obesity also is associated with increased pain.

Q: Do you hear from women that they were told their pain was all in their head?

ASALifeline: I have heard this repeatedly, and studies have shown that men reporting the same complaints receive more aggressive treatment.

AmericanPainSociety: This is a complex issue. Data are mixed, and provider characteristics (eg, gender) play a role, too.

StanfordPain: There are ways to deal with people who doubt your pain.2

Q: What kinds of pain are common in women but doctors don’t take seriously or don’t know much about?

ASALifeline: Back pain from childbirth and phantom pain from breast cancer surgery are just 2 of the sex-specific pains. Also, women feel pain due to a given medical condition or surgical procedure more intensely than men.

AmericanPainSociety: Fibromyalgia is much more common in women. No surprise, but some physicians tend to view this diagnosis skeptically.

StanfordPain: Many women experience low back pain during pregnancy. A physical therapist can help reduce the pain.

Q: What new research on pelvic pain should primary care physicians know about?

ASALifeline: Understanding gender differences is an important part of this. The Women’s Pain Update (https://www.asahq.org/WhenSecondsCount.aspx) has good information.

StanfordPain: There is exciting new research on pelvic pain from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) project.3

Q: What advice do you have for women with chronic pain, especially those who have repeatedly tried and failed to get relief?

ASALifeline: Seek professional help and don’t accept living in pain. Attempt other therapies in your treatment: injections, yoga, etc. (For more on women in pain, go to PracticalPainManagement.com)

AmericanPainSociety: Be your own strongest advocate. Great providers are available. Seeking help is an important coping skill.

Q: What are the consequences of “tolerating pain?” Is there a risk for more pain in the future due to central sensitization?

AmericanPainSociety: Good question. This could indeed increase long-term risks due to sensitization and other factors.

ASALifeline: It certainly could put you at high risk. Early identification and treatment are critical.

StanfordPain: Learn more about improving pain treatment for women from “Sex/Gender Disparity in Pain and Pain Treatment: Closing the Gap and Meeting Women’s Treatment Needs.”4

Q: What about menstrual pain or menstrual migraine, which women tend to tolerate? Is this a risk factor for future pain?

AmericanPainSociety: Hormonal factors may be related to increased pain in women, but this has not been well studied.

ASALifeline: It might not be a risk, but it certainly is more common to see chronic pain in women with history of menstrual pain.

Q: If catastrophizing increases reporting of pain in women, are medication-free treatments more effective for women?

AmericanPainSociety: There is limited evidence on this. Studies go in both directions. Treatment may need to be tailored for women.

ASALifeline: Women are more expressive about their pain. There are many options for them outside of medications.

StanfordPain: Pain Maps (www.painmaps.com) is an excellent resource that focuses on non-drug treatment alternatives for chronic pain.

Q: How do we rally as pain treatment providers and researchers to push Congress to improve funding for pain?

StanfordPain: This is why we need more funding for pain research to address this problem. Let your representatives know. Watch for the release of the National Pain Strategy from the U.S. Department of Health and Human Services in the next few months; this resource will provide national goals for pain care.

AmericanPainSociety: Agreed! Pain research funding lags far behind that for other diseases, even though pain affects more people.

—Reported by Kristin Della Volpe

Last updated on: May 25, 2017

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