In women, pain is thought of in different ways

Pain and Gender: What do we learn from Fleabag’s characters?” Drina Mogil, M.K. Barreveld and M. Chalmers

“Women are born with pain built in. Our physical destiny is ours. With those words, Kristin Scott Thomas’s character in the TV show Fleabag nailed a truth: that to be female is to be over-represented in statistics about pain.

The situation is changing, however. Barreveld says that she is seeing more grant applications, papers and conference presentations about pain in women. The number of studies involving both male and female animals is slowly increasing according to Mogil.

When women do seek help, many experience long waits to receive it. These long diagnostic delays are something we end up seeing. In Australia, she says, women typically have symptoms of endometriosis — a condition in which the tissue that lines the uterus grows outside it — for seven or eight years before they’re diagnosed. Chalmers says that delayed diagnoses for women are evident across a range of conditions, including acute ones such as heart attack for which women wait longer for diagnosis and intervention than do men14. They are less likely to have their pain treated well.

Many conditions, such as prostatitis, adenomyosis and endometriosis, affect 4%-16% of women and 2%- 10% of men. Antje Barreveld, a pain medicine physician at the Mass General Brigham inNewton, Massachusetts, said that there was a pain clinic in Boston that had stated that they wouldn’t see any patients with Pelvic Pain anymore.

The slow pace of change in achieving gender parity in research subjects is partly habit, partly a lack of consideration of the impact of sex and gender and partly not wanting to complicate the research. Mogil says that people stay away because of expectations that the data from female animals is going to be more variable. This isn’t the case. The male rodents aren’t as stable as the female rodents. “Whatever extra variability is going on in males — for example, dominance hierarchies, or when the last time they had a fight in their cage was — that ends up being more variable than the fluctuating female hormones,” Mogil says.

The idea that it wasn’t just neurons involved in pain messaging, but also microglial cells, had been viewed as one of the biggest breakthroughs in preclinical pain science, Mogil says. However, he adds, “people were missing huge swaths of the story, by focusing only on male animals and coming to conclusions that they then were happy to generalize to females.”

Given that women have higher stress responses than do men, as well as higher circulating levels of the neurohormone prolactin, Porreca speculated that prolactin might have something to do with their experience of pain. There was also evidence that people with tumours that secrete prolactin have a higher risk of headache and migraine10. Patients with high levels of prolactin, both male and female, had an increase in the number of headaches. This observation led him to conclude that prolactin was influencing the activation of pain receptors.

Real-time imaging of people’s brains while they were given painful stimuli suggests that pain is experienced in many parts of the brain, including the insula, the anterior cingulate cortex, the prefrontal cortex, the amygdala and wider somatosensory cortices. Natalie Osborne, a pain neuroscientist at the Gynecology Research Lab at NorthShore University Health System in Evanston, Illinois, is particularly interested in the subgenual anterior cingulate cortex, a region of the brain known to be involved in pain processing and that interacts with other parts of the brain differently in men and women.

The impact of sex and gender on the experience of pain first becomes apparent around puberty, says Rui Li, a pain epidemiologist at Seattle Children’s Research Institute in Washington. The emergence of sex differences in pain is caused by a combination of biological, psychological and social factors.

The effect oestrogen has on the perception of pain has been studied in laboratory settings and it paints a more complex picture. In 11 healthy women, one study found that they are more sensitive to thermal pain when their oest testosterone levels are higher but not the ischaemic pain that comes from performing hand- grip exercises around the arm.

Migraine, for example, is three times more likely to affect women than it is men — and episodes often occur within two days of the start of menstruation. The prevalence of migraine in people who have ovaries peaks during reproductive years and generally declines after menopause. Further cementing this link, the use of oestrogen-containing oral contraception can increase both the frequency and severity of migraines.

Pain: Recognizing the Power of Non-pharmaceutical Interventions (The Nature of Pain: recognizing the power of non-chemical interventions)” (Pain: acknowledging the support of Pacira Biosciences

Puberty is a time of major hormonal changes. The testes and ovaries need to be stimulated by the brain to produce testosterone and oestrogen, both sex hormones.

People spend much of their lives trying to soothe physical pain. The market for over the counter drugs was worth US$28 billion in 2022 and is expected to grow to over US$40 billion by 2032. The overconsumption of pain-management drugs, which can be addictive, continues to shatter lives.

Inflammations like endometriosis andFibromyalgia are often chronic and disproportionately experienced by women. There’s research linking chronic pain with the composition of the gut microbiome, which is raising hopes that it could provide relief for some conditions.

We are pleased to acknowledge the financial support of Pacira Biosciences Inc. in producing this Outlook. Nature has sole responsibility for all editorial content.

Source: Pain: recognizing the power of non-pharmaceutical interventions

How is Pain Described? What It Means, How It Hurts and How Well Does Pain Affect Its Patients?

The treatment of pain needs a more nuanced understanding of what it means. It has been discovered that pain-o-meter devices can bring objectivity to every first question: “where and how much does it hurt?” Scientists are looking into whether brain scans and blood tests can predict which treatments will work for individual patients, which would cause many people with chronic pain to stop looking for relief.