Pain - Differences Between Men And Women

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Gender aspects in pain medicine

The question of the extent to which women and men differ when it comes to pain has only been seriously scientifically investigated for a few years. Scientists largely agree that women and men generally express and feel pain differently - but not about how these differences can be explained.

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• Women are more likely to experience pain
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• Influence of hormones
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• Different effects of drugs
• Interactions between women and men
• Gender differences in clinical pain syndromes

Women report more intense and prolonged pain and report more pain-affected areas of the body when they have a painful condition. The female sex per se also seems to be a risk factor for the development of chronic pain. Various factors in combination seem to play a major role - biological, genetic and hormonal as well as psychological and socio-cultural. New findings show that gender plays a role in the occurrence of pain disorders, the perception and course of pain and probably also in the success of therapy.

Women are more likely to experience pain

Women are generally more likely to experience pain than men. This applies to almost all types of pain, such as headaches, migraines, and various forms of muscle, joint, and bone pain. Women also report more intense and prolonged pain and indicate more areas of the body affected by pain.

Age, social and psychological factors play an accompanying role, but are not decisive for the gender differences, as some examples show:

• Over a broad age range, ten percent more women than men complain of shoulder and neck pain. These types of pain become more common with age; the gender difference remains largely stable.
• Women only suffer from joint pain more often than men from the age of 45.
• Abdominal pain (not including menstrual cramps) decreases with age. However, they are seven to ten percent more common in women over their entire lifespan. Irritable bowel syndrome in particular affects women twice as often as men.

Men and women also differ in their susceptibility to diseases of the brain and other organs that can be associated with pain. Men are more likely to develop Parkinson's disease, Tourette's syndrome, and attention deficit hyperactivity disorder (ADHD). Women are at greater risk of developing depression, osteoporosis, fibromyalgia and autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and lupus erythematosus, as well as psychological disorders accompanying pain (e.g. anxiety, sleep disorders).

Women are more sensitive to pain

Experimental studies show that women are more sensitive to pain than men. With a certain heat or pressure stimulus, they estimate the pain intensity to be higher and withstand the pain less long. In addition, they already perceive lower stimuli as painful.

These observations suggest that the nervous system of women and men is “programmed” differently. The pain sensors - the nerve fibers that pick up pain stimuli and pass them on to the central nervous system - seem to be more sensitive in women. In addition, there are indications that the processing of pain in the central nervous system is significantly more sensitive in women, which favors the process of pain chronification. Compared to women, men can probably activate their body's own pain inhibition better.

Influence of hormones

Hormones, especially estrogen and progesterone, seem to have a major influence on pain sensitivity and processing. For example, migraines are typical of women of childbearing age. On the other hand, hormonal changes, especially during pregnancy, tend to lead to greater insensitivity to pain.

Estrogens appear to promote the development of chronic pain syndromes. Androgens are supposed to protect against this. Changes in plasma estrogen levels correlate with recurrent pain in women. The pain threshold and tolerance is highest in the follicular phase and lowest during menstruation. Postmenopausal women undergoing estrogen therapy are more likely to experience temporomandibular joint pain. An increase in pain sensitivity and a decrease in the pain threshold could also be observed.

Furthermore, a gender-specific relationship between chronic pain syndromes, the function of the so-called stress axis (hypothalamus-pituitary-adrenal axis, HPA axis), sex hormones and endogenous opioids was demonstrated.

Genetic factors

Genetic factors are also being researched. An example of a genetic link concerns the response of women with red hair and pale skin to certain pain relievers. Women and men with these external characteristics have a specific gene variant. But only in women does this have a meaning for the pain, although this gene is not on a gender chromosome. These women respond better to certain pain relievers than women without the gene variant and men (with and without this gene variant).

Different effects of drugs

Studies on the different effects of drugs in men and women are relatively sparse. Up until 1988, most drug studies were conducted exclusively on men because they did not need to be considered pregnant or influenced by hormone fluctuations.

Although the drug consumption is significantly higher in women, the data obtained from men are still often transferred to them. This can result not only in an inappropriate dosage, but also in intolerance.

For some painkillers, differences in the effects between women and men have recently been shown. Even opposing effects are possible. However, these have not yet found their way into pain therapy.

Interactions between women and men

Gender-specific interactions with effects on the experience of pain can also arise between the partners. Several studies provide evidence that in men, the affection and concern expressed by their partner when they are in pain intensifies the experience and behavior of pain. Women, on the other hand, remain largely unimpressed by the partnership's reactions when they are in pain.

Gender differences in clinical pain syndromes

Ratio of frequency	Women Men
migraine	2.5: 1
Tension headache	3: 1
Chronic tension headache	10: 1
Cluster headache	1: 3.5
Temporomandibular pain	1.5: 1
Facial pain	1.9: 1
Musculoskeletal pain	1.5: 1
Fibromyalgia	3.2: 1
Whiplash	1.3: 1
Rheumatoid arthritis	6: 1
Irritable bowel syndrome	4.0: 1
Pancreatitis	1.8: 4
Gallstones	3.4: 1

Table: provided by OÄ Dr. Waltraud Stromer