National Institutes of Health -- Gender and Pain: Program Summary

You probably learned the "telephone switchboard" story of pain in school. Touch a hot stove, the story goes, and a signal races from your finger along your spinal cord to your brain. Your brain perceives the danger and dispatches an urgent message to your hand. You yank your hand away.
Scientists now say pain is more complex than that. It's more like the Internet than an old-fashioned switchboard. A single stimulus may prompt multiple signals throughout the body. The pain you feel reflects an interaction between your basic cellular and genetic makeup, your current health, your emotional state, the situation in which the pain occurs, your past encounters with pain, and what you know and think about pain.		Male and female brains process pain differently
Whether you are male or female also influences how much pain you have, what type of pain it is, and how treatment affects you. Male and female brains process pain differently, according to speakers at a conference on gender and pain at the National Institutes of Health (NIH) in Bethesda, Maryland, in April 1998. The conference was the first to be wholly devoted to this topic. Some 500 persons attended the 2-day meeting. More than 30 researchers and clinicians described recent findings and progress toward developing safer and more effective ways to relieve pain.
"Sexual difference is biology's, that is, life's most potent experimental variable," noted conference speaker Karen Berkley, Ph.D., McKenzie Professor of Neuroscience at Florida State University, Tallahassee, Florida. Women report pain more often than men do, she said, and in more body regions. They also have more severe and more persistent pain. When women and men are given the same pain stimuli in laboratory studies--gradually increasing heat, for instance--women say "ouch!" before men do. Women discriminate better between types of pain.		Women say "ouch" sooner than men
Age and sex differences exist in the prevalence of many chronic pain conditions, according to Linda LeResche, Sc.D., research professor of oral medicine, at the University of Washington School of Dentistry, Seattle, Washington. Studying age/sex patterns, she said, may help identify causes of some pain conditions. Migraine headache, as one example, affects mainly women in their childbearing years, decreasing with age. This pattern suggests hormones may play a role in migraines. That is less likely to be true, she said, for a pain problem that continues to rise with age, such as joint pain. Despite their greater pain burden, speakers said, women handle pain better than men do. Women use more coping strategies, honed perhaps by their more frequent encounters with pain, in menstruation and in labor and childbirth. Women prepare better for pain, Berkley asserted. They plan tactics to handle it. Men more often say, "I'll deal with it when I have to." Even young boys and girls often differ in how they perceive and cope with pain. Many cultures around the world permit girls to be emotional, but discourage boys from showing pain. These attitudes then are carried into adulthood.
Gender differences are a relatively new focus for research. Until recently, scientists seeking to standardize data used only male animals in most laboratory studies of pain. In this way, they eliminated variations induced by normal, cyclic changes in female reproductive hormones.		Gender differences are a new focus for research
Many trials of new medications and other treatments excluded women, too. Potential harm to the fetus in pregnant women remains a concern. Some scientists claimed, however, that designing complex studies to include female animals and women would be too costly. Then, in 1990, the NIH launched its Office of Research on Women's Health, drawing attention to unmet needs in this area. The NIH Revitalization Act, signed into law by President Bill Clinton in 1993, requires that both women and minorities be included in NIH-funded clinical research. In 1996, the NIH established its Pain Research Consortium with representatives from all NIH divisions. Members of this group, plus other NIH centers and offices, sponsored the April 1998 conference on gender and pain. While most of the conference talks focused on basic understanding of the pain process, some offered insight into specific illnesses that patients and physicians can use today. More attention to gender issues should help ease pain for persons of all ages and both sexes. More information: Program: Schedule for April 7-8, 1998 conference Planning Committee: Conference Chair and committee members Sponsors: NIH Pain Research Consortium; pharmaceutical companies providing support Scientific Abstracts: Full text of conference abstracts Illness and Pain: Pain is the most common symptom of many illnesses. Osteoarthritis: Women use more varied coping strategies. Heart Disease: Before age 50, women have more chest pain but less heart disease than men do. Women over age 50 have more silent heart disease than men do. Migraine Headaches: One in 5 women and one in 17 men have migraines. Chronic Reproductive Organ Pain: Medications that relieve pain in one sex may not benefit the other. Fibromyalgia: This still mysterious disorder affects 9 times more women than men. Temporomandibular Disorder: Not just a regional pain problem. Postmastectomy Pain: It's often undertreated. Cancer: Severe pain may strike both sexes equally. Models of Pain: Women and men respond differently to dental surgery. Children and Pain: Normal, healthy children typically experience 4 acute pains and 1 achy pain each month. Managing Your Pain: Self-help tips. Future Directions: Focus on gender differences will benefit both sexes. In the News: Media takes on 'Sore Subject.' Conference highlights written by Lynne Lamberg.