There is no doubt that men and women experience the effect of chronic pain. The National Pain Strategy, developed in large part from the findings of the Institute of Medicine of the National Academy’s report, “Relieving Pain in America,” said “the public at large, particularly those living with pain, would benefit from a better understanding of pain and its treatment.” But chronic pain is chronic pain, regardless of whether a man or woman has it, right? So does gender matter?
Differences in pain
Men and women’s health are significantly different for a variety of reasons. Knowing this begs the question, “Are the risks for developing chronic pain different between men and women?” And, “Do men and women experience and report pain the same?”
In 2009, Roger B. Fillingim and colleagues concluded there is a growing body of evidence that indicates substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ between the sexes. In a different 2013 study, “Sex differences in pain: a brief review of clinical and experimental findings,” Bartley and Fillingim reported “an expansive body of literature suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women.” And researchers Pieretti S. and colleagues concluded the following in 2016: “It is becoming very evident that gender differences in pain and its relief arise from an interaction of genetic, anatomical, physiological, neuronal, hormonal, psychological, and social factors which modulate pain differently in the sexes.”
Evidence collected and reported over a significant period tells us that gender does matter. Women experience and report chronic pain differently.
What specific factors influence chronic pain in women?
As researchers have suggested, several factors explain why women’s experiences with chronic pain are different from their male counterparts. Understanding how these factors influence pain is important because differences are inherent with our genders and the study of chronic pain as a disease is relatively new. We don’t know why some people develop chronic pain and others don’t. However, some disorders are directly related to female anatomy, and others affect women at a higher rate than men. These include but not limited to
- painful menstruation
- child bearing
- ovarian cancer
- polycystic ovarian diseasefemale dominant disorders, such as chronic pelvic pain, irritable bowel syndrome, headaches (though cluster headaches are dominate in men), multiple sclerosis, Sjögren's syndrome, lupus, Crohn’s disease (a high incidence rate in women in their peak reproductive years), rheumatoid arthritis, osteoporosis (increased risk of bone fracture and physical trauma), jaw pain, painful bladder syndrome, fibromyalgia, chronic regional pain syndrome, and thyroid disease
Other considerations must also be made, such as differences in how sexual and other hormones influence our internal opioid system, according to Pieretti S. and colleagues in 2016.
Does the character of pain differ between men and women?
When we assess pain, we consider specific parameters such as:
- Location – Where is the pain?
- Character – How do you describe the pain, i.e. dull/sharp, numb/sensitive, isolated/radiating?
- Onset – When did it start? Is there an identifiable source, i.e. traumatic injury, either surgical or accidental, or a relatable disease process? What factors were present when the pain started? What was your age when the pain began?
- Duration – How long does it last. Does it come and go, or is it constant? Do symptoms wax and wane? Do you experience a flaring of symptoms? Is the pain episodic, such as migraine headaches or abdominal cramping during menstruation? Or, does your pain have a pattern, such as being worse at a certain time of the day?
- Intensity – Is the pain mild, moderate, or severe? How does the intensity interfere with activities of daily living, relationships, etc?
- Are there things you do that make the pain better or worse? What are they?
Many painful conditions can be experienced differently between the sexes. Take heart disease as an example. If we apply the assessment of pain according to the bullet list above, we know that men and women report their symptoms very differently and their risk factors are different too.
I think our understanding of pain experiences between men and women has a long way to go, and so does our understanding of chronic pain in general. However, when we look at the influence gender has on chronic pain, we can say — women experience and report pain differently.
Roger B. Fillingim, Christopher D. King, Margarete C. Ribeiro-Dasilva, Bridgett Rahim-Williams, and Joseph L. Riley, III. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. J Pain. 2009 May; 10(5): 447–485.
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013 Jul;111(1):52-8. doi: 10.1093/bja/aet127.
Pieretti S, D Giannuario A, Di Giovannandrea R, et al.
Gender differences in pain and its relief. Ann Ist Super Sanita. 2016 Apr-Jun;52(2):184-9. doi: 10.4415/ANN_16_02_09.
Ivana Plavšić, Tea Štimac, and Goran Hauser. Crohn’s disease in women. Int J Womens Health. 2013; 5: 681–688.