Pain not just in women's heads

Women are not wusses. They are designed to carry and deliver babies; the latter stage of the process is often thought to generate the worst kind of pain.

Nature makes it hard for women when it comes to pain: they not only endure a lot of it, they actually feel pain more acutely than men do.

It's not "all in their heads," as doctors have been known to tell women who don't get better on schedule. Women notice and complain about pain sooner, and more vocally, than males.

They even react to treatments differently, benefiting more than men from morphine-like opiates, but responding less to common painkillers such as ibuprofen.

And when they do receive treatment, they are often short-shrifted.

Doctors and nurses have long tended to under-treat pain, perhaps because they fear drug addictions.

A study of cancer patients found women got even less medication than men, says Dr Norman Marcus of Lenox Hill Hospital in New York, who is also in private practice at the Norman Marcus Pain Institute.

Despite this, women in pain cope admirably, other research shows.

That makes them heroes, not hypochondriacs or hysterics, says Dr Mark Allen Young, author of Women and Pain: Why It Hurts and What You Can Do.

Often dismissed as a mere symptom, pain is a public health problem costing a US$100 billion ($232 billion) a year, counting treatments, doctor visits and lost productivity.

"In my opinion, chronic pain is a women's health issue," says Roger Fillingim, a women's pain researcher at the University of Florida's College of Dentistry.

Pain itself remains mysterious. It is necessary to life, an early warning for burns, broken arms, sore throats, and tumours. But it is also exhausting.

"Persistent pain is garbage in the brain," Dr Marcus says. "It inhibits healing."

Dr Fillingim says: "Society assumes that the more pain you can take, the healthier you are."

But in some disorders, such as bulimia, patients have less pain perception. Sexual stereotyping also plays a role.

"Men are supposed to be tough, stoic and not expressive, to suck it up and deal, but it is more socially acceptable for women to be more expressive," says Dr Allen Lebovits at the New York University Pain Management Centre.

That means their complaints may not be taken as seriously as men's. And women have lots of pain: more headaches, arthritis and autoimmune disease; more knee problems, even as young women, and more intestinal trouble. They get fibromyalgia more than men and suffer more of certain injuries.

There are also female-only pains, cramps, breast tenderness and PMS.

Then there's the oestrogen factor. Experts blame hormones for a lot of pain complaints. For example, migraines often strike when oestrogen is high, although normal fluctuation in women's hormones has hindered research on this.

"I wouldn't say ... evil male scientists have maliciously ignored women over the years," Dr Fillingim says.

"It is just easier to study men because [researchers] don't want to mess with hormone changes."

Women may also be more vulnerable because they seem more susceptible to stress, which undermines the immune system and painkilling brain chemicals.

Other involuntary markers of pain show that men's pupils dilate less than women's when they feel pressure, and their muscle-flex response to ankle pain occurs later.

Nature has ways for women to cope. Sexual stimulation raises women's pain threshold, but not men's, which means pain they may experience can be helped by sexual activity. " 'I have a headache' is not a good excuse for [women] not having sex," Dr Fillingim says.

Because women's pain threshold rises in pregnancy, they're often given inadequate help during their most predictable trial, labour, says a pioneering biochemist, Professor Alan Gintzler of the State University of New York Downstate Medical Centre.

"The bottom line is that women are built differently," says Dr Young, who uses alternative and conventional therapies.

"Doctors need to realise that women have different pain thermostats, that women are not small men."

- NZPA

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