Managing Chronic Pain in Women

  • Welcome to March, Women’s History Month which marks the anniversary of the passage of the women’s right to vote. We’ve come a long way, baby; but, have we really come very far on the issues of women’s health? What would the grandmothers of women’s health think about where we are today? Florence Nightingale, a pioneering nurse who developed sanitary procedures like hand washing in the 1800’s, might be dismayed by the lack of health education in today’s society. Elizabeth Blackwell, the first woman to receive a medical degree and who founded one of the first hospitals for women and children, might be saddened to see the lack of research specific to women. Even though some of the modern day women’s health pioneers like Christiane Northrup, MD, who wrote a pivotal book called The Wisdom of Menopause, have continued to carry the torch and further health education for women; women’s health issues lag behind a primarily male dominated medical world. Women’s health does not begin and end with menopause, breast cancer and pregnancy. Look around, you are in the midst of an epidemic effecting primarily women, an epidemic of chronic painful conditions with names like fibromyalgia and thoracic outlet syndrome. Where is the pain relief?

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    One woman, a nurse (of course) from the University of California at San Francisco, Witney McKiernan RN  set out to find the relief for women in pain in her paper titled: A Review of Clinical Research and Pain Management in Women. She found that the lack of help for women in pain is due in part to the lack of research specific to women in pain. Well, the FDA prohibited the participation of women in clinical drug trials for years. That ban did not start to thaw until the late 1980’s. Now, we have something called the Women’s Health Initiative; however, there continues to be discrimination in early clinical trials and researchers are still failing to account for gender differences when the study cohort does include women. In the past fifteen years with the inclusion of women in the research of chronic pain, many gender differences have already been discovered. PET scans have documented that women respond to pain differently than men. Women-specific pain modulating systems have also been discovered like “pregnancy-induced analgesia." (Hey, here’s a thought: if you want pain relief, get pregnant.)


    The latest research (Pain, Tousignant-Laflamme, et al; 2009) has demonstrated that the pain threshold and pain tolerance levels fluctuate with the menstrual cycle. Of course, most of us women intuitively already know that we are built differently than men. Thank goodness, the medical community is finally proving it. The importance of including women in research studies and demonstrating the gender difference is in the discovery of better ways to treat women in pain.


    Women in pain have not been treated very well. Called too sensitive or emotional, many women have been swept into a vast dungeon of chronic pain. Some clinicians are starting to become aware of the gender-differences that should affect how they manage pain in women. Women react differently to medications due to different metabolisms, hormonal interactions, and clearance rates. As such, women are more prone to toxicity and adverse reactions to many medications used to treat pain. Hopefully, further inclusion of women into pain research will produce the data and knowledge base needed to guide clinicians in gender-specific treatment for women in pain.


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    All epidemics have been stopped through a process of education and proper treatment. The same will eventually happen for the epidemic numbers of women in pain. Where are the Florence Nightingale’s and Elizabeth Blackwell’s of our time who can lead the way towards better pain relief for women?  Now is the time for Women’s Health to include pain as an illness that targets women.

Published On: March 08, 2010