National Institutes of Health -- Gender and Pain: Future Direction

This conference makes it clear: in the realm of pain, gender matters. Once glossed over, gender differences today are at the forefront of the nation's pain research agenda.

Studies presented at the gender and pain conference emphasized these facts:

Women experience more pain than men.

Women discuss pain more than men.

Women cope better with pain than men.

Society's attitudes towards men and women in pain may influence physicians' treatment.

The open expression of pain sometimes helps people obtain better pain control. Being seen as "too emotional" may work against a person, however, and lead to inadequate care.

Pain treatment that works for one sex may not work as well or at all for the other.

These issues are particularly important as the population grows older: women, on average, live 6 years longer than men. In a recent report on managing chronic pain in older persons, the American Geriatrics Society estimated that 25% to 50% of older persons living in the community have pain problems. About 1 in 5 older persons reports taking pain-relieving medications several times a week. Pain problems are even more common in nursing homes. As many as 80% of nursing home residents may have substantial pain that is undertreated.

When using high dosages of potent medications, including morphine and other narcotics to relieve pain, physicians worry about the possibility of addiction. Such concerns, it turns out, usually are groundless. Persons who need pain relief seldom use their medications inappropriately.

Studies of persons who do abuse such drugs, however, may illuminate the pain experience, according to research reported at the conference by Jack H. Mendelson, M.D., professor of psychiatry (neuroscience) at Harvard Medical School and co- director of the Alcohol and Drug Abuse Research Center at McLean Hospital, both in Boston, Massachusetts. Studies of the different effects of pain-relieving drugs on men and women, Dr. Mendelson suggested, also may lead to better ways to treat substance abuse.

Gender and pain conference attendees agreed on these key issues for future practice and research:

Physicians need to consider gender when they diagnose illness and prescribe treatment.

Women need to pay attention to variations in illness and pain tied to their menstrual cycle, and to bring their observations to the attention of their physicians.

Men need to develop a broader repertoire of active coping strategies.

Parents need to give children age-appropriate information about medical procedures, telling them, for example, that an injection will sting. They need to help children receiving medical care understand what is happening, take charge of their bodies, and learn active pain-reducing coping strategies.

Researchers studying pain at every level, from the molecular and genetic to the clinical, need to assess the possible impact of gender. Use of males, whether animal or human, as the norm for research studies, is outmoded.