Women suffer more pain than men but are treated less
BY SUSAN FERRARO
New York Daily News
NEW YORK 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. And, in most cases, they are hardy
enough to survive the ordeal and nurture their infants to adulthood.
And yet nature makes it doubly 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 than their male counterparts.
They even react to treatments differently, benefiting more than men
from morphine-like opiates but responding less to common painkillers
like ibuprofen.
And when they do receive treatment, they're often given short-shrift.
Doctors and nurses have long tended to undertreat pain, perhaps
because some of the drugs used are addictive. But in a study of
cancer patients, women got less medication than men, says Dr. Norman
Marcus, who has a private practice at the Norman Marcus Pain
Institute in New York City.
Despite all 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" (Hyperion, $24.95).
Consider Maria Ramos, 48, a wife, mother and baby-sitter in the
Bronx, N.Y. For years, she complained of head, back and neck pain
that eventually spread to a knee. Her doctor blamed sinus problems
and migraines. "But I don't have that, none of the sinus," Ramos
says. "So I keep complaining. I feel bad, because I have all this
pain, and he doesn't do something." Eventually, she got a referral.
Pain specialist Dr. Paru Pandya focused on a herniated disk Ramos
had. The first medication didn't help, but a second approach
numbing muscle injections did. "The pain goes away in the arms, the
knee and the neck," sighs Ramos.
"Sometimes the doctors don't refer people in time," says Pandya. "We
see a lot of women with fibromyalgia, which is muscle aches all over.
It's horrible. The sad part is that they are not believed, not given
medication, and by the time they get to us it has affected
everything."
That's because one pain can lead to another, as a person favoring a
knee, for example, throws a hip out. Or, says Pandya, "They start to
be depressed. Then they have two problems, which might have been
prevented."
Often dismissed as a mere symptom, pain is in fact a $100 billion-a-
year public-health problem, counting treatments, doctor visits and
lost productivity. "In my opinion, chronic pain is a women's health
issue," says Roger Fillingim, a clinical psychologist and leading
women's pain researcher at the University of Florida's College of
Dentistry.
Yet pain itself remains mysterious. It is necessary to life, an early
warning when the body needs help: for burns, broken arms, sore
throats, tumors. But it's also exhausting.
"Persistent pain is garbage in the brain," Marcus says. "It inhibits
healing."
Our tough-it-out American ethic complicates the problem. "Society
assumes that the more pain you can take, the healthier you are,"
Fillingim says. But in some disorders, like 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 Center.
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 estrogen factor. Experts blame hormones for a lot of
pain complaints: For example, migraines seem to strike when estrogen
is high. Making matters worse, the normal fluctuation in women's
hormones has hindered research on the subject.
"I wouldn't say... evil male scientists have maliciously ignored
women over the years," 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 natural,
painkilling brain chemicals.
Fortunately, nature has ways for women to cope. Sexual stimulation
raises women's pain threshold, but not men's, which means pain women
experience can be helped by sexual activity. " ' I have a headache'
is not a good excuse for (women) not having sex," Fillingim says.
"The bottom line is that women are built differently," says Young,
who uses alternative and conventional therapies. "Doctors need to
realize that women have different pain thermostats, that women are
not small men."