For thousands of years, humankind has embraced the mindset that women are just “naturally” capable of withstanding more physical pain than men.
This widely held concept grew out of mistaken perceptions that: if women can regularly endure the agony of natural childbirth, the sometimes significant discomforts associated with menstruation, endometriosis and a variety of other gynecological issues, it means they must be able to tolerate more pain, more often than men.
A recent study now debunks this myth. In fact, it demonstrates that women feel pain twice as intensely as men do.
According to a report published in the October 2005 edition of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, women have 34 nerve fibers per square centimeter of skin and men have 17. Because they have more pain receptors than men do, women generally experience more pain than their male counterparts.
“This study has serious implications about how we treat women after surgery as well as women who experience chronic pain,” said Bradon Wilhelmi, MD, and author of the study.
A study conducted, partially by Tufts-New England Medical Center, found that in post-surgical situations, women reported higher levels of pain, and required more morphine than men in order to achieve a similar degree of pain relief.
Chronic Pain Plaques Women with More Frequency than Men
70 percent of the individuals who report experiencing chronic pain are women. A variety of medical conditions associated with chronic pain include Lupus, Fibromyalgia, Diabetic neuropathy, Osteoarthritis, Rheumatoid arthritis, Cerebral palsy, AIDS, Migraines and Parkinson’s Disease.
After experiencing chronic pain for long periods of time (often years), it is common for the woman to become emotionally discouraged.
“These conditions are often very difficult to treat because the patient’s pain levels are complicated to manage, and often accompanied by depression,” said Dr. Eli Zaller, Director of Psychiatry at St. Mary’s Hospital and Associate Clinical Professor at the VCU School of Medicine.
“This combination of chronic pain and depression can create an involved treatment situation for both physician and patient,” said Zaller
“Those who deal with chronic pain feel depressed because they experience a sense of being trapped by their
own pain. They feel hopeless because chronic pain is not easy to accept,”
“Along the way to acceptance of their pain, as a secondary complication, those who are clinically depressed continue to experience medical conditions such as fibromyalgia, which can be influenced by emotions,” said Zaller.
Professionals Recognize Differences in Pain Levels between Genders
During a 1998, a biomedical research presentation held by the National Institute of Health conclusions included:
• Women experience more excruciating pain than men do.
• Women discuss pain more than men do (perhaps because they have so much experience with it).
• Society’s attitude toward men and women in pain may influence physicians’ treatment (Some physicians discount women who express feelings of physical pain simply as an emotional or psychological issue)
• When women openly express their feelings about the existence of their pain, many times it provides them with a certain amount of control over it.
This particularly applies to women in chronic pain.
• However, when women present this same “feelings-related,” empowering behavior to some physicians, it may backfire. The physician may label them as “too emotional,” and if he mistakenly diagnosis her pain due to “oversensitivity,” it may ultimately lead to inadequate care.
• Pain treatment that works for one sex may not work as well on the other.
In medical circles, an evolution is occurring among the medical community. Many physicians are beginning to recognize that “one pain medication does not fit all.”
For instance, it is interesting to note that particularly in post-surgical situations;
morphine-like drugs work better on women than men. However, because women tend to experience post-surgical pain more excessively than men do, they require twice the dosage for pain management.
Physicians familiar with the differences in pain levels experienced by women and men are more inclined to develop partnerships with their patients regarding pain management.
DePalma, Director of VCU Spine Center, Addresses Pain Issues Daily
Richmond spine specialist, Michael DePalma, MD, Medical Director of the VCU Spine Center, whose training includes Board Certification in Physical Medicine and Rehabilitation, Pain Medicine and a Fellowship in Interventional Spine Care, focuses on the eradication of pain through the use of a variety of modalities.
DePalma said, “We see a great number of patients diagnosed with Osteopenia, which is the most common reason for fragility fractures among women. Osteopenia is a precursor to Osteoporosis.”
“Clearly women with Osteopenia present fractures that are painful, including back pain and pelvic pain. Our mission is to evaluate, identify and treat the underlying fracture and the condition which lead to it,” said DePalma.
DePalma added that treating a fracture and its attending pain is just the beginning of helping a patient gain an increased quality of life. DePalma treats any underlying metabolic disorder that may be a cause of the patient’s pain disorder.
“Osteoporosis leads to a lessening in bone density,” said DePalma. “This condition can cause a fracture while bending and tying shoe. At the VCU Spine Center, we address and identify pain, perform therapeutic interventions and perform procedures such as a Sacroplasty, which involves injecting synthetic bone cement in the affected site. DePalma said this procedure in particular provides a “fairly quick reduction in pain, then we are able to work on gait, balance, fall reduction, and appropriate exercises to help improve bone density and reduced future fractures.”
DePalma said some patients do well with pain medications, however, that type of regime usually creates the necessitation of increasingly higher dosages of medication. “Women tend to have more chronic, ongoing pain than men, which creates an environment that requires a variety of “pain relief” tools.
At the VCU Spine Center, DePalma is focused on making an accurate diagnosis in order to optimally treat the patient’s painful spinal disorder. Sometimes the discomfort may be a result of therapeutic algorithms (a problem-solving procedure designed with a finite number of steps), in conjunction with physical therapy. Antinflammatory drugs and steroids can sometimes affect a 50 percent improvement.
DePalma is currently conducting three clinical trials at the VCU Spine Center. In keeping with the academic medical environment, DePalma’s current trials involve: treating arthritic joints in the low back; reparative medicine for painful discs; and the efficacy of a percutaneous discectomy.
As one recent patient of Dr. DePalma’s said, “No one understands the pain women undergo. It’s even more difficult to describe what it is to, after years of pain, finally be pain free. I am tremendously grateful to Dr. DePalma and his knowledge of spine disorders.”
Primary Care Providers Care for Patients with Chronic Pain on a Long-Term Basis
According to Primary Care Provider at Virginia Physicians, Mark Davy, MD, ABFM, “Chronic pain goes with the territory of being a physician. Nothing is more individualized than a patient’s pain,” said Davy.
“In the office the most common type of chronic pain we treat is patients with Oeteoarthritis. However we also see a significant of number of patients with chronic hip and knee pain.”
Davy said treating chronic pain patients with strong medications may or may not be appropriate. “Some patients need regular doses of pain medication, which may bring them great relief. However, we also successfully treat chronic pain with joint injections. Others, such as those with Fibromyalgia, respond well to alternative medication such as the Lidoderm patch.”
“Our goal is to eliminate the patient’s chronic pain. However, with chronic medical conditions, most of the time we are treating the pain rather than the disease. Older women in particular are candidates for chronic pain management,” said Davy.
In fact, more than 10 million American women are approaching the age of 80. At this advanced age, they regularly experience painful medical conditions such as knee and hip replacements, heart bypasses, diabetic wound care and strokes. Once these situations are treated (usually surgically), the patient requires the additional medical attention provided by home health care clinicians. Usually, special attention to pain management is required for women recovering from invasive medical procedures.
Home health care patients, particularly geriatric clients, receive consistent pain management during their stay in the hospital. However, when that interaction ceases, and they return home, these individuals tend to assume an attitude that pain is a normal state of being.
Geriatric patients especially, often believe if they discuss their pain it would present a ‘burden’ to their loved ones. This mindset only encourages the elderly patient to tolerate higher levels of pain for longer periods of time. Subsequently, they tend to try to manage their pain by ignoring it.
Pain is one of the five vital signs. It is critical that clinicians, physicians, family and friends are diligent in helping ensure the optimum level of comfort for the individual experiencing pain. Appropriate pain management promotes quicker healing and faster recovery.