Most of us remember REM’s classic 80’s tear-jerker “Everybody Hurts”. Well, guess what ladies? It turns out women actually hurt more than our male counterparts!
Pain, whether physical or psychological, is common and inevitable. On average we undergo more than six surgical procedures in a lifetime, one in five of us live with chronic pain, and 50% of us will have experienced a mental health issue by age 40. But did you know that women have more pain than men?
Apart from the obvious (let’s see…period pain, sciatica in pregnancy, childbirth, breastfeeding, ovarian cysts, hysterectomies, mammograms…) women are two to six times more likely to develop chronic pain conditions like migraines, irritable bowel syndrome, fibromyalgia than men. Adding “insult to injury”, we also have rates of depression that are 1.7 x higher than men and women are TWICE as likely to have anxiety vs. men! What could be behind this?
Well, first, everyone’s experience of pain and pain thresholds are different, and women report greater pain severity than men, possibly due to some degree to physiological factors like having more nerve endings and thinner skin. But the fact we have more depression and anxiety may also be part of the equation. Dr. Ian Finkelstein, medical director of the Toronto Headache and Pain Clinic points out that depression, anxiety, and sleep issues are all very closely linked. While practicing headache and pain medicine for the past 23 years, he’s found that “a significant number of people who experience chronic pain also complain of depression and sleep problems. Clinically, the relationships that exist between these ailments often tend to be complex. Pain can disrupt sleep, and poor sleep can exaggerate pain intensity. This, in turn, may have an impact on both depressive symptoms and attention to pain.”
According to Dr. Lydia Hatcher, an Associate Clinical Professor of family medicine at McMaster University, Hamilton, Ontario who has specialized in pain management for over 30 years, “If one’s mood and mental health are not stable pain cannot be stable. We know pain can cause anxiety and depression, and anxiety and depression make physical pain worse.” So, effective pain management means making sure you are treating any mental health conditions and are getting good quality sleep. And the reverse is true - if you don’t treat pain effectively, mental health and sleep will likely suffer. (Translation: vicious cycle you do NOT want).
In terms of medications, there can be some differences there too. Women differ in their response to pain medications vs. men. For example, they tend to need higher amounts of pain medications immediately after surgery, certain medications can provide greater pain relief in women than men, and opioids like morphine and codeine can lead to more nausea and vomiting in women than men overall.
There are also big variations between individuals. Each one of us responds to medications differently. You may need entirely different drugs or doses to get relief than someone dealing with the same issue, so it can take time to find the right combination for each person. “Medications actually provide minimal pain relief on a 1 to 10 scale, and most will only relieve pain by about 20%. The other big issue is that not all medications have the same effects for all of us. I’m sure you have heard someone tell you how great a certain medication was, but it did nothing for you. Well, most therapies don't work for everyone because of our genetic differences” explains Hatcher.
Here’s an important fact: if you find yourself suddenly dealing with pain, maybe from an accident or surgery, it’s important to treat it as quickly as possible. Pain that continues for many weeks can change your brain “wiring” and the pain can become chronic (translation - much harder to treat). Research shows about 85% of those undergoing surgery report “moderate to severe” pain afterward, and about 20% end up developing chronic pain. Even getting effective treatment for depression and anxiety has its challenges; two-thirds of those who experience depression don’t respond well to the first medication prescribed and have to test out other drugs and doses. This can go on for months, and research shows that chances of getting better decrease with each drug trial.
So the name of the game is finding the drug and dose that works best for YOU as quickly as possible, not only for the obvious reason (pain is not fun), but also because treating pain properly and early can help minimize the risk of developing chronic pain and even your risk of developing opioid dependency from long term use of strong pain drugs.
Fortunately, the new science of pharmacogenetic testing can help. A 5-minute cheek swab home test from Inagene Diagnostics gives you and your doctor a “personalized roadmap”, listing the drugs likely to work best with the least side effects for you, based on your genes. “Until recently, we had no idea if the medication would help or make things worse with side effects” Hatcher explains. “Pharmacogenetics can help you choose the best medication for your genetic makeup. If you have pain and depression, there are drugs that work for both conditions that you might be a good candidate for. If you don't respond to a drug, knowing what others may work better for you makes it easier to try something new. Seeing that you have a higher risk of intolerance to a medication or whole class of drugs, or knowing you might be at a higher risk of getting 'hooked' on an addictive drug can be scary, but will empower you to make safer choices.”
Pharmacogenetics can also help with finding the right dose faster. Dr. Hatcher explains “If you tried a medication that didn’t work, genetic test results may show you just need a much higher than average dose, so then you can feel more comfortable seeing if a higher dose will work. Conversely, those who frequently have side effects often do well with very small doses. Knowing you are less likely to have side effects with a specific medication or that you should start with a much smaller dose gives you the power to be more in control of your body. When patients see their test results and finally understand why they were intolerant in the past it validates the negative experiences they have had.”
But ultimately drug treatment is only a small part of the solution. When it comes to managing any form of pain (or even with “psychological pain” like depression or anxiety), it is actually two non-drug factors that can make a huge difference: physical activity and mindset/psychological health. According to Dr. Hatcher; “Research shows the best therapeutic benefit actually comes from regular physical activity (cardio, resistance and strength training). It can decrease pain by up to 60%! No special tools are needed. Just walking (with your dog, stroller, in the mall) makes a difference. Swimming, yoga and tai chi can all help. Of course, seeing physiotherapists or occupational therapists are ideal to get started.”
And mindset and self-care are non-negotiables if you want to feel better according to Dr. Finklestein. “While cognitive behavioral therapy is useful in treating chronic pain, patients can also use simple tools such as relaxation therapy and meditation to effectively reduce pain and fatigue, improve sleep, as well as overall physical function and coping strategies.”
So ladies…yes it’s true - we hurt more. But Dr. Hatcher reminds us that knowledge is power, and science is showing there are proven ways for us to take back control of our bodies and our health. “We are in the early days of understanding how the genetics of our bodies ‘pain and mind’ centres work. It is exciting to know we are starting to get some answers.”