Gender Specific Bone & Joint Health: Pain Differences
WHAT WOMEN + MEN NEED TO KNOW TO LIVE THEIR MOST ACTIVE LIFE
What Are the Gender Differences in Pain?
Research shows that women are more prone to developing painful musculoskeletal problems and autoimmune conditions than men, and also have some differences in how they experience pain.
Social factors also play a significant role in the success of pain management treatments. These disparities should be factored into the development of care and treatment plans for those from different backgrounds.
Differences in Pain Perception
Just as the risk of many painful conditions is greater for women than men, research suggests women’s experience of pain tends to be greater too. Women report pain more frequently and have a lower tolerance to painful stimuli. In other words, even when men and women have problems that appear the same, women tend to feel and express more pain as a result. Two recent studies of men and women with knee osteoarthritis bear this out.
In the first, published in 2014 in Osteoarthritis and Cartilage, researchers assessed pain in 2,712 men and women with knee OA. The researchers found that women generally reported greater knee pain than men even when the severity of OA as shown in x-rays was equal. The difference was greatest in women with widespread pain, suggesting that central sensitization – a condition in which the nervous system becomes highly activated – may be an important contributor to pain in this group. In the second study, published in 2016 in Arthritis Care & Research, 288 men and women with knee OA completed a battery of pain assessments measuring their responses to cold, heat, mechanical pressure and pin-pricks applied to specific points on the skin. When compared to men, women exhibited greater sensitivity to pain stimuli, as well more widespread pain. These results suggest that enhanced central sensitivity may be an important contributor to pain in the women.
Why Women?
There is no single answer for why women experience more painful problems or more severe pain.
Possible factors include hormone and nervous system differences between men and women. Women’s hormones are different from men’s, and that is tied into the experience of pain. Studies in an animal study suggest the male hormone testosterone may provide a protective effect against pain.
Researchers found that depriving males of testosterone made them more sensitive to pain, while giving testosterone to female made them less sensitive. Giving them testosterone reversed their pain sensitivity. Women are also more prone to anxiety and depression, and these psychological factors and central nervous system functioning can put women at risk for greater pain.
Rethinking Treatment
If pain is different in men and women, experts suggest that treatment should be too.
Many currently used pain treatments were developed when clinical trials largely excluded women. The effectiveness of some pain relievers may not have been adequately studied in women, and some have now been shown to be less effective in women. For example, in a 2003 study, researchers found that women required 30% more morphine than men to control their pain following a surgical procedure.
Furthermore, narcotic pain relievers can have harmful side effects in women. To successfully treat pain, women may need to add treatments that focus on complementary and alternative therapies, and other mind-body treatments for pain, anxiety and depression. Women may also need different drugs or different doses of drugs than are used in men.