, , ,

Men vs. Women on Pain: Do Women Really Suffer More?

men vs women pain from spinal stenosis

If women feel more pain than men, do they need different treatment?

A popular myth tells us that women have a higher pain tolerance than men, after all, women are the ones who can go through the ordeal of childbirth, menstruation-related pain and other gynaecological problems. However, a new study suggests that women report higher pain levels than men, which could have an effect on pain management programmes and the treatment of chronic conditions such as back pain from spinal stenosis. Focusing in pain reporting may do women a disservice, however, as the authors of this study do not appear to have accounted for earlier research indicating that women may actually feel more pain, not just report more.

Gender Disparity in Pain Reporting

In this latest study, the records of 11,000 male and female patients at the Stanford Hospital and Clinics were analyzed to determine reports of pain occurring across a range of diseases and conditions. A clear gender disparity was found as to how much discomfort the patients reported, with women more likely, overall, to report higher levels of pain than men.The study looked at forty-seven disorders, including back conditions, cancer and infectious disease, and over 161,000 pain scores were assessed. An eleven-point scale was used, with zero representing ‘no pain’ and eleven equalling ‘the worst pain imaginable.’

Higher Reports or Higher Pain in Women?

The lead author of the study, Dr. Atul Butte, Chief of Systems Medicine, Department of Pediatrics at Stanford University School of Medicine, noted his surprise that the gender difference was true for almost all of the diseases assessed. “We completely wouldn’t have expected such a difference across almost all disorders, where women were reporting a whole pain point higher on the 0-to-10 scale than men,” Butte said. Rather than accepting that this provides evidence that women experience more intense pain than men, the authors of the research seem to consider this as predominantly a reporting effect.

Do Women Feel Pain Twice as Intensely?

Such self-reported pain scores are, of course, influenced by each patient’s definition of pain tolerability but the emergence of a clear difference between how men and women experience pain across such a large number of patients suggests there is a real disparity. What the study does not mention is that many pain medications have, traditionally, been tested on male patients, with the effects of numerous medications largely unknown for women and children. The study also fails to note earlier research indicating that on average women have twice as many nerve fibers per square centimeter of skin (34 to 17 in men) and, thus, have more pain receptors than men. This 2005 paper, published in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, concluded that women experience more pain than men.

Women and Men – Pain Management Differences

The paper’s author, Bradon Wilhelmi, MD, noted that “This study has serious implications about how we treat women after surgery as well as women who experience chronic pain.” After surgery women were found to report higher levels of pain and require more morphine than men to achieve a similar degree of pain relief. A new study suggests that using resveratrol alongside morphine improves response, especially in chronic conditions. Importantly, the effects of pain relief were assessed, unlike in the more recent study which only assessed reports of pain prior to treatment. Butte has indicated the need for further research in this regard.

Why Women Report Pain Differently than Men


It could be that differences in attitudes when treating male and female patients also account for part of the disparity as women may feel more inclined to rate pain higher in order to have their suffering deemed worthy of treatment after experiences with dismissive medical practitioners. Conversely, male patients may downgrade their own pain experience to adhere to cultural stereotypes of tough masculinity. An interesting study would look at the levels of pain reported by men and women when asked by healthcare staff who were male or female; the presumption is that male patients would report less pain overall when female staff were asking them to rate their pain.

Oestrogen and Pain Levels

Butte and colleagues suggest that hormonal differences may account for the disparity in reported pain between men and women. Oestrogen has been shown to dampen some pain receptors, thus causing a higher tolerance to pain in women. Where oestrogen levels then drop, during and after menopause, and also just before menstruation, women’s pain tolerance would also be reduced.

How Physicians View Women’s Pain

That there are so many reasons why men and women seemingly report pain differently makes for a confusing picture for clinicians. Butte says that “The reasons may be biological or they may not be, but we should still be aware of the bias that patients have in reporting pain.” It may be, however, that such research leads physicians to subconsciously downplay pain reported by women or exaggerate pain reported by male patients, leading to a peculiar situation with a presumed bias on both sides when discussing pain management.

Women in Chronic Pain

Differences in how men and women access healthcare may also influence these results, with men and women dealing with chronic pain, such as back pain from spinal stenosis, in a variety of ways. The majority of patients living with chronic pain conditions are women, making up some 70% according to some evaluations. The reasons are myriad, with more women living longer and developing chronic conditions that cause pain, as well as being more frequently diagnosed with conditions that cause chronic pain such as Lupus, fibromyalgia, rheumatoid arthritis and migraines.


Stress, Pain and Women

Chronic pain can cause patients to become despondent and pessimistic about their condition, so looking at the results of this study in order to assess a difference between men and women with either chronic or acute pain conditions would, perhaps, be more revealing. In addition, chronic pain and the depression and stress related to it, may actually trigger further ill health and the development of conditions such as fibromyalgia, insomnia or other sleep disorders. Stress, depression and poor quality sleep all decrease tolerance to pain.

Women’s Pain ‘A Burden’?

Women may also be considered more likely to hide their pain from loved ones in order to not be ‘a burden,’ only to then go on to rate their pain highly when discussing their condition in private with their physician. An unfortunate irony of the health system is that although many women have been found to benefit from a feeling of empowerment if they openly discuss their feelings about their chronic pain, presenting pain in this way to a physician can lead them to dismiss such symptoms as purely emotional or psychological. This was noted back in 1998 at a biomedical research presentation at the National Institutes of Health where other conclusions were also reached:

women and back pain spinal stenosis worse than for men

After childbirth and a lifetime of period pains, do women still suffer more than men from back pain?

  • Women experience more intense pain than men do
  • Women discuss pain more often than men, possibly because they experience it more
  • As a product of culture, women’s pain is often dismissed as psychological or social, rather than a physical reality that is treatable
  • Pain management that works for men may not work for women

This latter point is demonstrated by the fact that opioid painkillers appear to work better for women than men but that other analgesics may not work as well. As women experience more intense post-surgical pain than men their dose of painkillers is likely to need to be higher, sometimes twice as high as for men. That the majority of surgeons, particularly spine surgeons, are male may also affect pain management as men have been found to be more likely to develop a partnership with their patients to treat pain. Such a partnership may result in the use of a multimodal programme of pain management, such as using steroids alongside physical therapy and analgesics, thereby keeping medication doses low but still effective.

Gender-Specific Pain Management Programmes

This latest research then, may cause some physicians to see the take-home message as being that women report pain more highly than men with similar conditions, unfortunately ignoring the possibility that their female patients are actually experiencing higher amounts of pain. Treating female patients with higher doses of medication than male patients may also be considered unusual, particularly where dosage is calculated by body weight. Perhaps the only way to solve these quandaries are through clinical trials assessing difference in response in men and women of already approved and commonly used painkillers. Tailored pain management programmes are also important, especially when treating chronic pain from spinal stenosis or other condition that is becoming increasingly prevalent in the ageing population.

References


Mowlavi A et al. Increased cutaneous nerve fibers in female specimens. Plastic and Reconstructive Surgery. 2005; 116:1407-1410

Schwartz JB., Gender differences in response to drugs: pain medications. J Gend Specif Med. 1999 Sep-Oct;2(5):28-30.

April 1998, NIH Pain Research Consortium conference, “Gender and Pain: A Focus on How Pain Impacts Women Differently than Men.”

Paller CJ, Campbell CM, Edwards RR, Dobs AS., Sex-based differences in pain perception and treatment. Pain Med. 2009 Mar;10(2):289-99. Epub 2009 Jan 16.

2 replies
  1. Stephen Driver
    Stephen Driver says:

    The plastic surgery study shows women have twice as many pain receptors as men in FACIAL SKIN so for problems like chronic back pain this is irrelevant and thus was left out.

    Reply

Trackbacks & Pingbacks

  1. […] This may indicate a biological difference affecting pain, including the increased number of small nerve fibers in cis-women, but could also illustrate gender differences in experienced and reported pain. […]

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *