Will this hurt doctor? Much more if you are a woman

Discussion in 'Fibromyalgia Main Forum' started by tansy, Aug 25, 2008.

  1. tansy

    tansy New Member


    Will this hurt, doctor? Much more if you are a woman.

    The sexes feel pain differently, but most drugs have been trialled mainly on men

    By Nina Lakhani
    Sunday, 24 August 2008

    Women experience more severe pain, more often and for longer than men but are less likely to get the right treatment, researchers have discovered.

    Different hormones, body composition and central nervous systems means women are more susceptible to a range of painful conditions, according to the International Association for the Study of Pain.

    Better understanding among health professionals of sex differences in pain could save lives, prevent thousands of sick days, and would save the country millions of pounds, an international pain conference in Glasgow was told last week.

    The majority of doctors are ignorant about research revealing genetic, biological and hormonal differences in the way pain affects women. Many are unaware that common treatments such as paracetamol are less effective for women and that they are more likely to suffer side effects.

    Long-term conditions such as migraines, irritable bowel syndrome, arthritis and fibromylagia are much more widespread in women.

    Despite this, many women are still not believed by doctors and given a psychiatric diagnosis instead. Depression often accompanies pain but it is rarely the cause.

    Dr Beverly Collett, consultant at Leicester's pain management service and chair of the Chronic Pain Policy Coalition, said: "It is only in the past 10 years we have started to understand these differences, and it remains an under-researched area. But even the knowledge we have has not filtered down and the average GP has no idea that drugs such as paracetamol and morphine work differently in women."

    An extensive Swedish study last year confirmed that women having heart attacks are more likely to feel generalised pain in their shoulders and back rather than shooting pain in the chest and left arm. Most doctors and nurses are unaware of these differences, which has life-threatening consequences for women, said Dr Collett.

    Until recently, most pain studies were carried out on male rodents, and the majority of drug trials on men. Researchers started to investigate sex differences less than 10 years ago.

    Work by brain imaging experts at Oxford University has found women with untreated painful periods are more likely to react to other painful stimuli because of changes in the brain. These findings suggest that untreated persistent pain makes women more susceptible to a lifetime of painful conditions.

    Professor Irene Tracey, director of the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, said: "Our preliminary data suggests there are long-term health consequences of not taking monthly period pain seriously. The images show increased activity in different brain regions which suggests untreated pain permanently changes the brain and central nervous system. This could explain why multiple painful conditions are much more common in women."

    She added: "The next stage for us it to find out whether these changes are permanent, or if this is recoverable when the pain is treated properly."

    One in eight people in the UK suffers from migraine. The attacks are three times more common in women, and tend to last for longer than in men. Pioneering research by Dr Ann McGregor at the City of London Migraine Clinic has found a strong link between migraines and low oestrogen levels, common during menstruation and after the menopause.

    England has no NHS strategy for tackling pain, while Scotland does. Nearly eight million Britons suffer with chronic pain. Lord Darzi, the junior health minister, did not mention it in his recent wholesale review of the health service.

    Experts believe pain should be recognised as a disease in its own right. Dr Collett said: "Better access to multidisciplinary pain services is essential for these women. The economic and social benefits for society are clear."

    Car accident has led to a life of agony

    Rosanna Notaro, 36, from north London, has been in pain ever since a serious car crash in 2003. Her initial injury was to her neck, but she now suffers from severe backache, migraines and stomach problems which have left her anxious and unable to work. Her pain is worse during her period, but she doesn't understand why. Her first GP didn't believe her, and she was forced to spend thousands of pounds on private doctors and therapists. Her new GP finally referred her two years ago to an NHS pain clinic, where she hopes to see a specialist doctor and psychologist. She is still on the waiting list.

    Ms Notaro said: "At first, I presumed the pain would eventually go away and I would get better. I didn't expect to develop chronic pain, or that it would stop me working and lead me to consider suicide. My problems have arisen from a combination of an initial misdiagnosis and inappropriate treatments. I'm taking 20 tablets every day, but still some days I can't get up. I just want my life back."

    Nina Lakhani
    [This Message was Edited on 08/25/2008]
  2. tansy

    tansy New Member

    September 2, 2005

    A study published this month in the journal Arthritis & Rheumatism looks at how decreased estrogen, particularly from breast cancer treaments called aromatase inhibitors, as well as natural menopause, cause arthralgias or joint pain and musculoskeletal aching.

    Researchers David T. Felson, MD, MPH, of the Boston University Clinical Epidemiology Research and Training Unit, and Steven R. Cummings, MD, of the California Pacific Medical Center Research Institute and the University of California, "reviewed the evidence linking ... estrogen deprivation with arthralgias" so that they could bring awareness within the medical community to this problem.

    The review showed that joint pain and inflammation can activate pain receptors, enhancing sensitivity to pain. Research also shows that inflammation can cause the receptor fields to enlarge so that more pain stimuli can reach the brain.

    Estrogen is known to influence inflammation and pain receptors. In fact, "estrogen has direct effects on opioid pain fibers in the central nervous system," according to the researchers.

    Not only do pregnant women, who have high levels of estrogen, have elevated pain thresholds, but animals who are not pregnant, but who are given pregnancy levels of estrogen, also have an elevated pain threshold.

    Aromatase inhibitors are used in the treatment and prevention of breast cancer, in part by decreasing the level of estrogen in the body. Women being treated with these medications have a higher instances of arthralgias than women on tamoxifen or placebo.

    In one study, 12 of 77 women with breast cancer being treated with anatrozole (an aromatase inhibitor) had arthralgias and five percent of the total women treated discontinued treatment due to persistent and severe joint pain. The pain went away after the treatment was stopped

    Estrogen production also decreases after menopause. Menopausal arthritis can be found as early as 1925 when researchers described "a painful arthritis developing two to five years after menopause." Menopausal arthritis is found more commonly in Asian women than in Caucasian women. Women treated with hormone replacement therapy had a significantly decreased occurrence of "bodily pain."

    The researchers state that while the effect of estrogen on arthritis is unknown, "most common forms of arthritis have their highest incidence and prevalence in postmenopausal women." One study cited suggested that trial monkeys deprived of estrogen showed early signs of developing osteoarthritis, which was then prevented with estrogen therapy. The same results do not apply to rheumatoid arthritis.

    What does this mean for you?
    The researchers conclude by noting that a "small but significant" number of women being treated with estrogren-depleteing medication develop arthralgias. The joint pain can be remedied through estrogen therapy or discontinuation of the medications depleting the estrogren.

    If you are being treated with one of these medications and also have been experiencing joint pain or have been diagnosed with arthritis, talk to your doctor about treatment options that may reintroduce estrogen into your body and, hopefully, put an end to your joint pain.
  3. tansy

    tansy New Member

    Women More Sensitive To Pain During Periods Of Low Estrogen
    Main Category: Pain / Anesthetics
    Article Date: 02 Feb 2006 - 19:00 PDT

    Several recent studies have found that women are more sensitive to pain during periods of low estrogen. Now researchers are going one step further by studying whether the difference in pain sensitivity is reflected in brain activity as measured by functional magnetic resonance imaging (fMRI).

    In an article published in the February 2006 issue of the Journal of Oral and Maxillofacial Surgery (JOMS), researchers document how they measured brain activation using fMRI, before and after painful heat stimuli.

    The research team studied nine healthy, pain-free women 19-33 years of age, acquiring data during a period of high estrogen and a period of low estrogen. Researchers attached a small thermode to each subject's lower cheek near the jaw, and then administered intermittent, high-temperature stimuli. Blood samples were taken after each scan to verify the appropriate level of estrogen.

    They found that estrogens appeared to influence the activation pattern caused by painful stimulation. "The results of this study suggest that the affective component of pain may be enhanced during the low-estrogen phase of the menstrual cycle in healthy women," concluded lead researcher Reny de Leeuw, DDS, PhD.

    Estrogens appear to regulate several neurotransmitters systems in the brain, acting as vasodilators and increasing blood perfusion in the brain.


    Saving Faces, Changing Lives -- The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 7,000 oral and maxillofacial surgeons in the United States, supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.

    AAOMS's headquarters is located at:
    9700 West Bryn Mawr Ave.
    IL 60018
    Tel: (847)678-6200.

    American Association of Oral and Maxillofacial Surgeons

    Source: Medical News Today
  4. tansy

    tansy New Member

    When she thinks back on it, Janine Willis figures the nightmare began 20 years ago, when she injured her neck in a relatively minor car accident. But an operation in 1992 seemed to resolve the problem, giving her five fantastic years. Then, in 1997, she re-injured herself pruning an apple tree in her backyard. And the downward spiral began.

    For the next eight years, Ms. Willis, now 43, of Castro Valley, CA, visited dozens of health care professionals and underwent numerous treatments. She lost valuable years in her young children's lives and placed her marriage on autopilot as she moved through her days in a fog of pain.

    Through it all, too exhausted from the pain and pills to even get out of bed some days, she still had to convince people that her pain was real. Despite the pills, the shots and the physical therapy, despite the fact that doctors couldn't find anything wrong with her neck anymore, she hurt. Really hurt.

    She's not alone. A 2005 nationwide survey sponsored by Stanford University Medical Center, ABC News and USA Today found that more than half of all Americans have either on-again, off-again pain or daily chronic pain, with about four in 10 saying their pain interfered with work, mood, day-to-day activities, sleep and their overall enjoyment of life.1

    "Pain is a huge problem, just huge," says Sean Mackey, MD, PhD, an assistant professor of anesthesiology and pain medicine at Stanford University School of Medicine in Palo Alto, CA. "Chronic pain is one of the primary reasons patients go to see health care professionals, and the number one reason people are out of work in our society."

    Overall, studies find, about 72 percent of chronic pain sufferers are women, with many chronic pain conditions, like migraine and fibromyalgia, much more common in women
    than men.2

    Plus, studies find, women report more serious and more frequent pain than men, as well as pain that lasts longer. Women are also more likely to seek treatment for pain. Yet, women and minorities are also more likely than men to have their pain under treated.3,4,5

    In fact, despite renewed attention to the topic in recent years, the under treatment of pain--in women and men--continues to be a significant problem in our culture.3

    "All too often, pain management is poorly done," says Anita J. Tarzian, PhD, RN, a former hospice nurse who is now a health care ethics consultant. "There's so much injustice and ignorance in the health care community about pain, and so many misunderstandings. It's frustrating, and makes me angry when I think of people who could get relief but don't."

    Dr. Mackey is a little more optimistic. "We're doing better than we used to," he says, but he admits, "We still have a tremendous way to go." On the bright side, he notes, "we're starting to get the message out that chronic pain should be viewed as a disease in and of itself, and not just as a symptom of a disease."

    Defining Pain
    So just what is pain? Well, that depends on who you are, where you are, how you were raised and what you're doing when the pain strikes.

    "Pain is, by its very nature, a subjective experience," says Dr. Mackey. "It's not like treating diabetes or hypertension, where we can measure blood pressure and blood sugar and directly correlate it with the symptoms."

    Acute pain is pain related to a specific cause, like burning your hand or breaking a leg. It occurs when electrical signals from the damaged tissue travel to the brain in a process called nociception. The pain itself doesn't occur until those signals hit the brain. Or, as Dr. Mackey likes to say, "No brain, no pain."

    With chronic pain, however, the perception of pain can exist without the electrical stimulus. So, for instance, say you had a back injury that has now healed. But you still have the pain. That's because your nervous system is now generating and sending electrical signals on its own to the brain, so you continue to perceive pain. It's as if the feedback loop from the brain to the tissue and back again has become stuck in the "on" position.

    Sometimes, both chronic and acute pain occur together, as with cancer pain. For Ms. Willis, the pain felt like being trapped and continually out of control. The worst part wasn't just the pain itself, but its effect on her life. "Your family falls apart, your house falls apart," she says.

    Although she took numerous medications for the pain, the treatment was often as debilitating as the pain itself, leaving her tired and foggy. "I used to tell my doctors I felt like I was living my life in Jello," she says.

    And her doctors, while well-meaning, could often be quite condescending. "They'd say, 'Your family is going to have to realize that you just can't participate like you used to.' And I'd say, 'No. That's not how I want to live my life. I'm not going to accept this.'"

    Because she wouldn't settle for less, she was often labeled a "bad patient," Ms. Willis says.

    That's not unusual, says Dr. Tarzian, who wrote a seminal review article on the way the medical profession treats women with chronic pain. For instance, she noted, research finds that women in chronic pain experience "disbelief or other obstacles at their initial encounters with health care providers," and that they're more likely than men to be given tranquilizers and antidepressants for the pain than pain medication.3

    To reduce your risk of that type of encounter and insure your pain is treated seriously, Dr. Tarzian suggests women take these steps:
    • Educate yourself about your pain and treatment options to help build your confidence when talking with health care professionals.
    • Be prepared for a physician's reluctance to prescribe opiates, and be ready with information to counter that reluctance, if opiates are an appropriate treatment option.
    • Know that there almost always are options that can improve your quality of life and ability to function if you experience chronic pain, though there's not always a guarantee that treatment will significantly reduce or eliminate it.
    • Ask a friend or family member, even another medical professional, to help you get what you need, if you don't feel you can speak up for yourself.

    And if you have a bad experience with a medical professional, she suggests writing a letter to the state medical board. Medical boards are just beginning to sanction doctors for under treating pain these days.

    Treating the Pain
    Here again, women differ from men. Studies find that women differ in their response to some pain medications, says Dr. Mackey, specifically opiates, which seem to work best in men. Yet one class of opiate (nalbuphine [Nubain] and butorphanol [Stadol]) that binds to certain brain receptors seems to work best in women. Although the data is still preliminary, says Dr. Mackey, "clearly women are wired differently from men, and their response to medications may turn out to be much different."

    That's one reason an individualized treatment plan for chronic pain is so important. Today, says Dr. Mackey, pain experts focus on four main areas from which to mix and match treatments: pharmacologic management, physical management, interventional management and psychological and behavioral management.

    Pharmacologic Pain Management
    Medications for treating acute and chronic pain range from aspirin (and other non-steroidal anti-inflammatory drugs) to muscle relaxants and opiates. Opiates, which all bind to specific receptors in the central nervous system, are available in a variety of different delivery methods: oral, injectable, rectal, transdermal (e.g., fentanyl patches) and intraspinal (e.g., implanted morphine pumps). Additionally, numerous drugs approved for other medical conditions have been found to work for pain, including antidepressants, antiarrhythmics (drugs used to correct irregular heart beat) and anticonvulsants (drugs used to prevent seizures). In fact, the first antidepressant approved by the U.S. Food and Drug Association (FDA) specifically for the treatment of painful diabetic peripheral neuropathy, duloxetine (Cymbalta), hit the market in late 2004.

    Physical Pain Management
    This includes such things as acupuncture, chiropractic, occupational and physical therapy, exercise and massage. All have various benefits, depending on the individual and the type of pain. Additionally, practitioners help educate individuals about body mechanics, pacing activities and setting goals to manage pain symptoms.

    Several studies have demonstrated the effectiveness of acupuncture in chronic pain. An analysis of 22 studies on acupuncture found it relieved lower back pain better than no treatment at all, or a placebo treatment,10 while other studies find it also works well for osteoarthritis of the knee.11 Small wonder that the Stanford/ABC/USA Today poll on pain found five percent of American adults have turned to acupuncture for pain relief.1

    Another common treatment with good evidence behind it is transcutaneous electrical nerve stimulation, or TENS, in which a device delivers a mild electrical current to the outside of the body in the painful area, interfering with pain messages. The effects can last for hours or even days after the treatment ends in some people.

    Interventional Pain Management
    This is probably one of the fastest growing areas of pain management. It includes things as simple as injections of steroids directly into the spinal cord and injections of pain medication directly into the nerve triggering the pain to more invasive technologies like spinal cord stimulators, or neuromodulation, in which an implanted device sends a mild electrical current through the nerves to block pain signals from hitting the brain. This is the treatment that finally relieved Ms. Willis' pain.

    Psychological and Behavioral Pain Management
    This involves various mind/body therapies ranging from cognitive behavioral therapy (CBT), in which you learn how your thoughts and feelings change your pain and how to control them, to relaxation techniques, including meditation, mental imagery and biofeedback. One analysis of 25 clinical trials examining an array of mind/body interventions in managing rheumatoid arthritis found significant benefits in this approach, particularly for people recently diagnosed.12 Additionally, a National Institutes of Health Technology Assessment Panel found moderate to strong benefit for these techniques in the treatment of chronic pain.

    Often, several mind/body approaches work best. For instance, in one study of osteoarthritis patients, those who learned about their disease, engaged in physical activity, problem solving, relaxation, and developed skills to communicate more effectively with family and health care professionals, reduced their pain and disability an average of 15 to 20 percent. Other studies find similar benefits using mind/ body therapies for fibromyalgia, back pain and other forms of chronic and acute pain.12

    Even playing music can help, with studies finding it reduces the perception of pain in older adults with chronic osteoarthritis and in cancer patients. When played during or after surgery or painful medical procedures, patients have less pain and use less pain medication.13

    Overall, studies find that using several techniques together (physical, pharmacologic, interventional and psychological/behavioral) in an integrated comprehensive manner provides the best results.14

    Finding Relief
    Despite the range of treatments available, chronic pain sufferers still have difficulty finding health care professionals who can effectively treat their pain. A 1998 survey by the Pain Foundation of America found that one in four have changed doctors at least three times.15

    Janine Willis lost track of the number of doctors she saw by the time the caseworker her HMO assigned to her case finally got her into the Stanford Pain Clinic.

    "Many doctors specialize in only one type of pain treatment. There are few comprehensive pain clinics like Stanford's, which take a holistic approach to pain management," she explains.

    Ms. Willis spent an entire day at the clinic undergoing evaluation, everything from detailed medical histories to a screening to see if opiate drugs worked for her (they didn't). Finally, she got what she'd come for--a neuromodulation implant. The device was implanted on March 3, 2005, and as soon as it was turned on, the pain vanished. Today, Ms. Willis controls the level of stimulation herself, adjusting it depending on her pain and activities.

    Only now that she can go to her kids' soccer games, plant the huge vegetable garden the family used to have, and prune and care for the 30 fruit trees on their property, she says, does she realize how many aspects of her life the pain touched.

    "Everyone is happy now," she says. "There is just this new hopefulness."X

    Source: The National Women's Health Resource Center
    [This Message was Edited on 08/25/2008]
  5. PainPainGoAway

    PainPainGoAway New Member

    Hi Tansy,
    This is pretty interesting. It reminded me of a set of sisters who baffled doctors at how individually they responded to pain medications.
    Have you heard of conjoined twins who respond differently to the same pain meds?
    I watched a documentary on these two wonderful girls when they had to each have surgery for scoliosis. Although the same weight and height, and joined, one sister needed more pain meds than her twin to control her level of pain. On the other hand, the twin who couldn't tolerate the med at such high levels had to watch her sister endure more pain because it was too dangerous to overmedicate the one who couldn't tolerate a higher dose, in the body they share.

    This was true for antibiotics as well.
    Maybe you can find some information on this. The girls are not suffering from our conditions but the fact that this occurred in two similar bodies was fascinating. I couldn't find any information directly on that but maybe someone else knows about it. They are 18 now.

    I know they don't want to be up for any studies, but I'm sure there is information out there.
    It makes sense that even among women, individually, our pain levels are distinctive.
  6. victoria

    victoria New Member

    maybe at least now they'll (EVENTUALLY) stop writing us off as hysterical?

    So much is biochemically determined, so I'm not even surprised at the conjoined twins even tho they're twins. I knew of a woman with multiple personality disorder who suffered from life-threatening shellfish allergy in one personality, but not the other 2.

    If they can ever really truly connect the brain with the body and vice-versa, maybe some things will get solved; but I think that's a long ways off.

    all the best,

  7. simonedb

    simonedb Member

    wow victoria
    that is fascinating, how did they explain that? its hard for me to comprehend that different parts of the brain could be allergic depending on what personality is in control.

    thx tansy, validating research
  8. victoria

    victoria New Member

    EEGs done on MPDs show different brain wave patterns even, depending on which personality they're in...

    which I'd guess then causes the biochemical changes? I'm guessing, haven't read the research since, altho at the time there wasn't any answer.

  9. tansy

    tansy New Member

    has often been seen as a predominantly psychosomatic disorder; that's why it's taking so long for the medical profession to recognise the importance of treating women's pain effectively and with the right meds.

    I know many here have problems getting pain meds. I posted these articles to provide them with more information to give to their doctors so they can get the Tx they need and deserve.

    tc, Tansy

    [This Message was Edited on 08/27/2008]