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Battle of the Sexes (Ouch!)

3/12/2014

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by Nari Lee '17
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Sex differences can create problems both in pain and its treatment. This topic adds yet another aspect to today’s complex sex/gender equality debate, but it’s highly relevant for anyone who experiences pain – namely, everyone. Research has revealed that males and females perceive pain differently, yet management of pain for men and women doesn't take that into account. In fact, treatment of pain is often generalized for both sexes (or worse, biased). Instead, doctors should tailor treatments to the differences in female and male bodies’ responses to pain and pain medicine. To do this, though, greater research is needed on sex-specific responses to pain treatments.

Different Responses to Pain

Current research shows that compared to men, women experience more frequent and more severe levels of pain, along with pain of longer duration (1,2). When subjected to the cold pressor test (where the subject submerges a hand in ice water for as long as they can), males are usually more pain tolerant than females (3). These differences can have biological roots; for example, they can be due to the influences of gonadal steroids (4), the production and regulation of which differ by sex.

Men and women also differ in responses to pain treatments. Another study supports the hypothesis that sex may affect responses to an interdisciplinary pain management treatment (5). It has also been shown that women experience greater levels of analgesia from opioids than men do (6). 

The ways that pain can currently be treated are many, ranging from the previously mentioned opioid analgesics to alternative therapies such as acupuncture. Studies of male and female responses to every method are difficult to conduct, though, because of variations introduced by the female reproductive hormones (7). Other barriers are the additional resources required to include female animals and women in studies and potential harm to the fetus in pregnant females (7).
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The pathway of a pain signal

Research Focus

Due to the previously mentioned factors, most scientists were still using only male animals in laboratory studies of pain, as recently as just over a decade ago (7). As a result, the availability of sex-comparative research on responses to pain medicine and treatments is limited. This shortage restricts the information available to medical practitioners when designing appropriate treatment plans for patients in pain.

Though some scientists claim that experiments including female subjects would be too costly (7), the overall cost of ineffective treatments as a result of sex differences would be greater. If doctors were to base treatments off of data from male-centered research, then women would not be receiving adequate or appropriate management of their pain. Women have already been proven to use medical services more often (8) and increase healthcare costs accordingly; male-based research would only increase those costs as women continue to seek care for their unsatisfactorily treated pain. 

The Effect of Social Perceptions of Sex (i.e. Gender Bias)

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Taking into account the gender bias that is present in physicians’ approaches to treatment exacerbates matters. A physician will often offer different treatments to men and women with the same condition (9). Research indicates that when suffering pain from AIDs, women are more likely than men to be under-treated, and more specifically, less likely to receive analgesics (10). This seems to contradict the previously mentioned data showing that women respond better to analgesics. If a physician knows that women respond better to analgesics, why are they prescribing less? What’s more telling, though, is that physicians are more likely to attribute pain to psychosomatic causes in women than in men (11). They also tend to take male patients more seriously than female patients (12). Unfortunately, commonly held social perceptions of sex seem to disfavor females in the clinical environment.

Conclusion

A delicate balance must be reached between sex-biased treatments and equal treatment of pain for patients. Standardized outlines for the prescription of analgesics or other methods of pain management would help promote equality, but they would also disregard the inherently different responses of the two sexes’ bodies to those treatments. As pain medicine progresses, practitioners should aim towards this careful balance, though difficult to achieve. With the publication of more research and reviews on the subject of sex differences, the trouble of doing so is no longer an acceptable excuse.

  1. Unruh AM. Gender variations in clinical pain experience. Pain [Internet]. 1996 May-Jun [cited 2013 Nov 11]; 65(2-3): 123-167. Available from ScienceDirect: http://www.sciencedirect.com.revproxy.brown.edu/science/article/pii/0304395995002146 
  2. Andrasik F, Holroyd KA, Abell T. Prevalence of Headache Within a College Student Population: A Preliminary Analysis. Headache: The Journal of Head and Face Pain [Internet]. 1979 Nov [cited 2013 Nov 11]; 19(7): 384-387. Available from Wiley Online Library: http://onlinelibrary.wiley.com.revproxy.brown.edu/doi/10.1111/j.1526-4610.1979.hed1907384.x/abstract;jsessionid=AD5EFB23A3C9E73E2D1B7EDDA64E4FC8.f01t04  
  3. Geisser ME, Robinson ME, Pickren WE. Differences in cognitive coping strategies among pain-sensitive and pain-tolerant individuals on the cold-pressor test. Behavior Therapy [Internet]. 1992 Winter [cited 2013 Nov 12]; 23(1): 31-41. Available from ScienceDIrect: http://www.sciencedirect.com/science/article/pii/S0005789405803065 
  4. Al-Azzawi F. Perception of pain in males and females. Gender Medicine [Internet] 2006 [cited 2013 Nov 11]; 3(Supplement 1): S19. Available from ScienceDirect: http://www.sciencedirect.com/science/article/pii/S1550857906800136
  5. Keogh E, McCracken LM, Eccleston C. Do men and women differ in their response to interdisciplinary chronic pain management? Pain [Internet]. 2005 March [cited 2013 Nov 22]; 114(1-2): 37-46. Available from ScienceDirect: http://www.sciencedirect.com/science/article/pii/S0304395904005780 
  6. Gear RW, Miaskowski C, Gordon NC, Paul SM, Heller PH, Levine JD. Kappa-opioids produce significantly greater analgesia in women than in men. Nature Medicine [Internet]. 1996 Nov [cited 2013 Nov 12]; 2(11): 1248-1250. Available from nature.com: http://www.nature.com/nm/journal/v2/n11/abs/nm1196-1248.html    
  7. Lamberg L. Gender and Pain: Program Summary. National Institutes of Health [Internet]. 1998 Apr [cited 2013 November 9]. Available from: http://painconsortium.nih.gov/genderandpain/summary.htm
  8. Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract [Internet]. 2000 Feb [cited 2013 Nov 12]; 49(2): 147-52. Available from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/10718692 
  9. Hamberg K, Risberg G, Johansson EE, Westman G. Gender Bias in Physicians’ Management of Neck Pain: A Study of the Answers in a Swedish National Examination. J Womens Health Gend Based Med [Internet]. 2002 [cited 2013 Nov 9]; 11(7): 653-666. Available from: http://online.liebertpub.com.revproxy.brown.edu/doi/pdfplus/10.1089/152460902760360595 
  10. Breitbart W, Rosenfeld BD, Passik SD, McDonald MV, Thaler H, Portenoy RK. The undertreatment of pain in ambulatory AIDS patients. Pain [Internet]. 1996 May [cited Dec 8]; 65(2): 243-249. Available from ScienceDirect: http://www.sciencedirect.com/science/article/pii/0304395995002170
  11. Berstein B, Kane R. Physician’s attitudes toward female patients. Medical Car [Internet]. 1981 Jun [cited 2013 Nov 12]; 19(6): 600-608. Available from Jstor: http://www.jstor.org.revproxy.brown.edu/stable/info/3763923?&Search=yes&searchText=Attitudes&searchUri=/action/doBasicSearch?Query=%2528Physicians%2527+Attitudes+toward+female+patients%2529+AND+jid%253A%2528j100274%2529&Search=Search&gw=jtx&prq=%2528Physician%2527s+Attitiudes+towards+female+patients%2529+AND+jid%253A%2528j100274%2529&hp=25&acc=on&aori=off&wc=on&fc=off  
  12. Calderon, KL. The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles [Internet]. 1990 Dec [cited Dec 8]; 23(11/12): 713-725. Available from EBSCO: http://rl3tp7zf5x.scholar.serialssolutions.com/?sid=google&auinit=KL&aulast=Calderone&atitle=The+influence+of+gender+on+the+frequency+of+pain+and+sedative+medication+administered+to+postoperative+patients&id=doi:10.1007/BF00289259&title=Sex+roles&volume=23&issue=11-12&date=1990&spage=713&issn=0360-0025
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