These pains in women are really not "pretentious"!

Pain has been listed by the World Health Organization as the fifth vital sign after heart rate, respiration, pulse and body temperature, and has become the third largest health problem after cardiovascular and cerebrovascular diseases and tumors.

Statistics show that the incidence of chronic pain diseases in women is significantly higher than that in men . For example, the incidence of migraine in women is twice that of men. Endometriosis can cause pelvic pain in 10% of women of childbearing age, dysmenorrhea in adolescence, labor pain, and chronic low back and leg pain caused by childbirth.

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These chronic pain problems seriously affect women's lives, work and studies. With the development of social economy, the improvement of women's education level and the enhancement of self-awareness, the long-ignored chronic pain problem in women is receiving more attention and becoming an important health issue that needs to be solved urgently.

01. What is chronic pain?

Chronic pain refers to pain that lasts for more than 3 months or recurs repeatedly, often accompanied by mood disorders, sleep problems, and impaired social function. Studies have shown that the prevalence of chronic pain in women is significantly higher than that in men. The World Health Organization (WHO) and the International Association for the Study of Pain (IASP) define it as "unpleasant sensory and emotional experiences associated with actual or potential tissue damage" [1].

02. Why are women more likely to suffer from chronic pain?

The occurrence of chronic pain in women is closely related to hormonal differences, biological characteristics and social and psychological factors. These factors work together to make them more sensitive to pain than men and more susceptible to chronic pain.

1. Hormone Differences

Cyclic changes in estrogen levels in women can increase pain sensitivity, such as menstrual migraines and pelvic pain. As women age and enter perimenopause (commonly known as menopause), chronic pain (such as low back pain, joint pain, and general muscle aches) becomes a common symptom due to decreased estrogen levels and osteoporosis[2].

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2. Biological differences

Nerve endings in women are more densely distributed than in men. For example, facial skin contains about 34 nerve fibers per square centimeter, while men only have about 17, about half of that in women. This difference makes women more sensitive to pain stimuli and the pain spreads over a wider area; in addition, the OPRM1 gene can enhance the analgesic effect in men, but may increase the pain sensation in women [3,4,5].

3. Social and psychological factors

While growing up, men are often taught to be strong, while women are encouraged to express their emotions and show their vulnerability, which may cause them to pay more attention to and amplify related emotions when facing pain.

In addition, women often assume more roles and responsibilities in society and face more sources of stress, such as social opinion, family pressure, and emotional repression.

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These factors interact with estrogen levels, differences in brain structure and function, and neurotransmitter levels to make women more susceptible to negative emotions, which in turn enhance pain perception and further promote the development of chronic pain[6].

03. Why is chronic pain so difficult to diagnose?

1. Outdated social concepts

In the past, there were widespread misconceptions in society such as "just bear with minor illnesses" and "everyone feels pain, just bear with it", which made it difficult for patients to get timely diagnosis and treatment. Women were especially asked to "bear with pain", for example, pain during childbirth and menopause was often considered "normal".

At present, labor analgesia has been fully included in medical insurance and promoted nationwide, which has significantly improved the problem of labor pain compared with 10 years ago and has won wide acclaim from the society. However, it is still necessary to strengthen publicity, promotion and financial support in economically underdeveloped areas and populations.

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Sociologists should pay attention to women's self-identification and cognition of pain and promote advanced experience in the prevention and treatment of chronic pain; medical scientists need to explore cutting-edge, effective, convenient, economical, non-addictive and easy-to-promote analgesic methods.

2. Gender bias

Foreign studies have shown that 75% of female patients reported that doctors underestimated their pain levels, often attributing it to “emotional” or “psychological problems.” In addition, when women seek medical attention for pain, their chief complaint is more likely to be misdiagnosed as anxiety or depression [7,8].

3. Disciplinary limitations

The mechanism of pain is complex, involving multiple disciplines such as neurology, endocrinology, psychology, and interventional therapy. Traditional specialized treatment models are difficult to fully cover. In addition, pain medicine started late in China, there is a shortage of specialists, and primary care doctors have obvious limitations in their understanding of women’s pain[9].

04. What should I do if I have chronic pain?

When facing chronic pain, you can relieve your emotions through mind-body exercises (such as Pilates and yoga), or divert your attention through meditation, regulating your breathing, etc. [10]; however, if the following situations occur, it is recommended to seek medical attention immediately:

1. Persistent pain of unknown cause : such as headache, chest pain, abdominal pain, back pain, leg pain, etc. lasting for more than 3 months.

2. Severe pain (VAS ≥ 7) : such as perineal pain (similar to labor pain) or trigeminal neuralgia, timely intervention treatment is required.

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Use the VAS score to assess pain severity

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3. Pain associated with loss of function : such as inability to walk due to sacroiliitis, or limited mobility due to severe periarthritis of the shoulder.

At present, some hospitals have opened pain departments, and patients can directly register for treatment. For hospitals that do not have pain departments, patients can obtain treatment recommendations through online consultations (some hospitals have been connected to intelligent assistance systems such as DeepSeek), or go to general internal medicine, general surgery, obstetrics and gynecology and other related departments for screening.

The scope of investigation includes potential causes such as infection, vascular disease, neuropathy, tumor or autoimmune disease, and somatic symptoms need to be identified. If necessary, professional support from a psychologist can also be sought.

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Chronic pain not only affects women's physical health, but also profoundly affects their psychological state and quality of life. However, with the deepening of medical research, the change of social concepts and the improvement of the medical system, we have reason to believe that women's chronic pain problems will be addressed more accurately and effectively.

Only through the coordinated advancement of science, humanities and policies can we build a more inclusive and effective support system for female chronic pain patients and truly realize the medical vision of "no need to endure pain and life with dignity".

References
[1] Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain, 2015, 156(6): 1003-1007

[2] Obstetrics and Gynecology Editorial Group. Obstetrics and Gynecology (10th Edition) [M]. Beijing: People's Medical Publishing House, 2021.

[3] Mogil, JS, & Bailey, AL (2010). Sex and gender differences in pain and analgesia. In Handbook of behavioral neurobiology (Vol. 8, pp. 363-382). Springer New York

[4] Smith, SB, et al. (2006). Sex differences in the functional genetics of mu-opioid receptor (OPRM1) and its relationship to pain sensitivity. Pain, 125(3), 260-268.

[5] Smith, JD (2005). Gender differences in pain perception and its relief. Plastic and Reconstructive Surgery, 116(5), 1234-1240

[6] Fillingim, RB, Smith, SB, & Robinson, ME (2009). Sex Differences in Pain and Analgesia: From Molecules to Males and Females. The Journal of Pain, 10(11), 1071-1075.

[7] Hoffmann, DE, & Tarzian, AJ (2001). The girl who cried pain: A bias against women in the treatment of pain. Journal of Law, Medicine & Ethics, 29(4), 346-353.

[8] Hoffmann, D., Fillingim, R., & Veasley, C. (2022). The Woman Who Cried Pain: Do Sex-Based Disparities Still Exist in the Experience and Treatment of Pain? Journal of Law, Medicine & Ethics, 60(4), 720-735

[9] China Pain Medicine Development Report Editorial Group. China Pain Medicine Development Report[M]. Beijing: People's Medical Publishing House, 2020.

[10] Zhang, H Bi, Y Lu, X Hou, X Tu, Y & Hu, L. (2021). The role of negative emotions in sex differences in pain sensitivity[J]. NeuroImage.

Author: Liu Kaiwei, resident physician at Changning District Maternal and Child Health Hospital

Planning & Editing: Tiara

Acknowledgements: Peng Ting, Director of the Obstetrics Department of Changning District Maternal and Child Health Hospital and Doctor of Medicine of the School of Clinical Medicine of Fudan University, provided scientific guidance for this article.

Title image source: The Legend of Zhen Huan