The New England Journal of Medicine published a study revealing that women are seven times more likely inappropriately diagnosed and discharged in the middle of having a heart attack compared to their male counterparts.
You might be wondering what heart attacks have to do with chronic pain. Bear with me. It has a lot.
Gender bias in the medical system
The gender gap spans the entire medical field. Until recently, research studies were predominantly conducted on men. Because the menstrual cycle creates unpredictability in carefully controlled research trials, women have often been the least desirable test subjects. This has led us to understand most diseases, their treatment and diagnosis through the lens of male physiology.
70% of individuals suffering from persistent pain are women. Yet, 80% of studies on pain are conducted on male subjects.
One of the few studies exploring the gender differences in pain experience found that women tend to feel pain more often, for longer, more intensely and in more parts of their body.
Women with chronic pain suffer longer than men. Women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain in the emergency room, while men wait around 49 minutes.
Researchers also found that when male and female patients expressed the same amount of pain, female patients' pain was viewed as less intense. While their male counterparts received medication, women were more likely encouraged to seek psychotherapy. This exposes a significant patient gender bias highlighting a dangerous truth - women are not believed about their bodies.
While there is still no definite answer as to why women experience pain differently than men, below are some factors that may contribute to this.
Different Nervous Systems
One of the reasons why women are likely to feel more pain than men is because they have as much as twice as many nerves per square centimetre. The more nerves you have, the more information can be transmitted to your brain.
Furthermore, the female brain processes pain differently than the male brain.
More self-awareness, for better or worse
Women are more self-aware of what is going on in their bodies. Thus, women are more likely to notice when something is wrong. Women regularly visit healthcare providers for regular checkups like pap smears. Thus they are more attuned to changes within their body.
This can be beneficial, but it also can come at a cost. Anxiety and worry about health make women more prone to catastrophic thinking and hypervigilance. Both factors are known to amplify and prolong pain.
Hormones
Receptors that connect to hormones such as estrogen, progesterone and testosterone also pick up and transmit danger signals from the body to the brain.
Furthermore, testosterone is anti-nociceptive. This means it blocks or reduces danger messages sent from the body to the brain. Testosterone circulates in higher amounts in men. Thus, reducing pain severity in men.
But it doesn't stop here. Pain sensitivity varies throughout the menstrual cycle. Women tend to be more pain sensitive during ovulation, menstruation, and the luteal phase.
Psychosocial Factors of Pain
Research highlights that women are more likely to experience childhood trauma.
Childhood trauma negatively influences brain development and stress resilience. Thus, early childhood trauma is linked to increased incidences of chronic pain alongside other chronic illnesses.
Later in life, women are also 8-25 times more likely to experience abuse in adult relationships than men, further perpetuating the chronic pain cycle.
Bottom line
There is no such thing as imagined pain. All pain is real, and the sooner we can overcome gender biases in pain care, the sooner appropriate pain care can be given to both women and men.
References:
Arthur J. Barsky MD Heli M. Peekna PhD Jonathan F. Borus MD, (2001), "Somatic Symptom Reporting in Women and Men". Journal of General Internal Medicine, Volume16, Issue 4, Pages 266-275
Fillingim, R.B. (2000), "Sex, gender, and pain: Women and men are different." Current Review of Pain 4, 24–30.
PhD Zsuzsanna Wiesenfeld-Hallin, (2005), "Sex differences in pain perception" Gender Medicine Volume 2, Issue 3, Pages 137-145
Channing J. Paller, MD, Claudia M. Campbell, PhD, Robert R. Edwards, PhD, Adrian S. Dobs, MD, MHS, (2009), "Sex-Based Differences in Pain Perception and Treatment" Pain Medicine, Volume 10, Issue 2, Pages 289–299,
E.J. Bartley, R. B. Fillingim, (2013), "Sex differences in pain: a brief review of clinical and experimental findings" BJA: British Journal of Anaesthesia, Volume 111, Issue 1, Pages 52–58.
I.Jensen, A.Nygren, F.Gamberale, I.Goldie, P.Westerholm, (1994), "Coping with long-term musculoskeletal pain and its consequences: is gender a factor?" Pain, Volume 57, Issue 2, Pages 167-172
Lanlan Zhang, Elizabeth A. Reynolds Losin, Yoni K. Ashar, Leonie Koban, Tor D. Wager. "Gender Biases in Estimation of Others’ Pain.", The Journal of Pain, 2021
Office of National Statistics: Child abuse in England and Wales: March 2020
Sari M. van Anders, Jeffrey Steiger, Katherine L. Goldey, (2015), "Effects of gendered behavior on testosterone in women and men" Proc Natl Acad Sci U S A; 112(45): 13805–13810
Jan Hendrich, Pedro Alvarez, Elizabeth K. Joseph, Luiz F. Ferrari, Jon D. Levine, (2012), "In vivo and in vitro comparison of Female and Male Nociceptors" J Pain; 13(12): 1224–1231
Science News, (2005), "Study Reveals Reason Women Are More Sensitive To Pain Than Men" Science Daily
Diane E. Hoffnann, Anita J. Tarzian, (2001), "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain" Joumal of Law, Medicine &Ethics,29: 13-27
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