Women and Chronic Pain: Getting the Help You Need

Most women who have weathered childbirth while their squeamish male partners stood by might think they are warriors when it comes to pain tolerance. However, research indicates that women are actually more sensitive to pain, and women tend to develop more chronic pain conditions and experience more pain during their lifetimes in general. Yet health care professionals can minimize, misdiagnose, or offer insufficient relief for the pain conditions women report. Although men may delay getting the treatment they need for pain, once they seek help, they are often treated with more aggressive and larger doses of pain medication.

According to the International Association for the Study of Pain (IASP), there are gender differences in how pain is experienced, diagnosed, and treated. Women are more likely to have lower pain thresholds and to identify more severe, long-lasting, and recurrent pain. In addition, their susceptibility and response to pain is often affected by their menstrual cycles. Some medical conditions are also more prevalent among women. For example, the ratio of women to men among migraine sufferers is 2.5:1; the ratio for fibromyalgia is 4:1. Women also experience gender-specific pain conditions, such as painful menstrual periods, and chronic non-menstrual pelvic pain affects 15% of women of reproductive age. Women often respond differently to pain medication and non-pharmacological pain treatments and may experience different side effects from medications.

Many women with chronic pain also have multiple pain conditions. According to the IASP, a person with overlapping pain conditions runs a greater risk of disability, psychological distress, and the development of new pain conditions than someone with a single pain condition. The Overlapping Conditions Alliance claims that at least 50 million women suffer from one or more chronic pain conditions, such as fibromyalgia, chronic fatigue and immune dysfunction syndrome (CFIDS), interstitial cystitis, vulvodynia, endometriosis, and temporomandibular joint (TMJ) disorders. Examples of other chronic conditions include rheumatoid arthritis, lupus, irritable bowel syndrome, inflammatory bowel disease, osteoarthritis, migraine headaches, chronic back pain, and other autoimmune diseases. These conditions not only cause physical suffering, but impose an emotional and financial toll on women and their families. The impact of decreased work productivity, avoidance of social activities, limitations in sexual functioning, and changes in one’s sense of identity create a tremendous burden. Adding to this, women may spend years seeking a diagnosis, feel scorned and dismissed by the medical establishment, and believe that others suspect their symptoms are psychological. Even when an appropriate treatment is prescribed, there may be limitations in insurance coverage, powerful side effects, or disappointing results.

On May 19, 2010, The National Vulvodynia Association, Endometriosis Association, TMJ Association, and CFIDS Association, with the cooperation of the US Congressional Caucus for Women’s Issues, started the Campaign to End Chronic Pain in Women on Capitol Hill. They presented their report Chronic Pain in Women: Neglect, Dismissal and Discrimination and advocated for greater research funding into diagnosing and treating these conditions. They documented that the failure to diagnose and treat the conditions increases the direct and indirect annual cost to America’s annual health care by up to $80 million. However, research funding for these conditions in 2009 averaged only $1.33 for every woman affected. The Campaign’s goal is to advocate for equitable funding for underrepresented chronic health conditions.

To get the help you need, recognize that most health care providers want to help, but they may feel rushed and pressured due to time constraints, or get frustrated when pain problems do not resolve easily. Sometimes, however, providers may have difficulty empathizing with the pain you experience, or they may not have the necessary training and experience to accurately diagnose your condition. When working with a health care professional, try to become as educated as possible about your condition. Make a list of your concerns before each visit, and prioritize each question so that the most significant problems are the first to be addressed. A pain diary can be useful, with details about activity level, food, medications, stress, or other relevant information, along with a pain rating scale with ratings from one to ten describing the severity of your pain from day to day. Be as factual as possible, and give specific examples of how the pain affects your ability to function at home, school, or work. Ask questions and set specific goals with your health care provider, and work out a treatment plan so that you feel that you are also in charge of your treatment. Most importantly, women and their families need to advocate for increased research funding, and ensure that women receive greater access to the care they need.

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