Features September 2010 Issue

Do Men and Women Feel Pain Differently?

Possibly—but not in the stereotypical ways you might expect.

Think men are stoic creatures who endure pain by gritting their teeth and pretending they don’t feel anything? Or that women tend to express pain, ready to describe it in vivid detail? It’s time to overturn such stereotypes, says Teresa Dews, MD, vice chair of the Pain Management Department at Cleveland Clinic. "Over the years, I’ve seen plenty of stoic women and expressive men," says Dr. Dews. "The perception that men won’t talk about pain, while women

have no trouble expressing their feelings, reinforces biases that interfere with appropriate treatment."

Research from the late 1990s and in early 2000 suggested that women react to pain differently than men and that they have a lower pain tolerance than men. Some researchers have even speculated, based on laboratory studies, that women’s pain receptors are different from men’s. But existing studies don’t show a cause-and-effect relationship between any particular human trait or physiological finding and pain sensitivity or expression, Dr. Dews stresses. Moreover, no available treatments are specifically geared to gender, ethnicity, or other variables, so even if differences were shown, they should not affect treatment.

 

What matters

"We’re becoming more aware of subtle differences, not only between men and women, but between individual patients—and these are related to genetic makeup," Dr. Dews explains. "However, we don’t yet have treatments directed toward the genetics of pain." Sociocultural factors are also important, both from the patient’s perspective and the caregiver’s perspective, Dr. Dews says. "You may have one patient who is more demonstrable about their pain and another who is more stoic, and their complaint may be taken more or less seriously depending on their presentation. How the complaint is viewed depends not only on the gender of the patient, but also on the doctor, who may harbor the same stereotypes that patients have, and therefore take a woman’s pain complaints less seriously than complaints from a male, simply because the doctor believes that a man will only talk about pain if it really hurts."

Moreover, says Dr. Dews, a male doctor may have less tolerance or understanding about a woman’s pain complaints than a female doctor would.

Socioeconomic factors affect pain treatment, because they affect access to care, Dr. Dews notes. "We know that a person’s health insurance status or ability to pay for treatment is a significant barrier. But we also know that ethnicity plays a role in pain treatment, even when people have similar access to care. We haven’t identified and quantified all the barriers to treatment, but we know they exist, and they add another layer of complexity to patient care."

If an individual does not have easy access to pain treatment, "they may use other coping mechanisms," Dr. Dews says. "Many people modify their lifestyle because of pain, and end up sitting on the couch all day, instead of getting the attention and the treatment that would reduce their pain."

 

Help your doctor understand

When it comes to pain, your goal is to get your doctor to treat you as an individual, Dr. Dews stresses. To help ensure that this happens, write down the following about your pain and bring it with you to your doctor’s office

• When you experience pain—what were you doing when you felt pain?

 

• Where it hurts—in one particular spot, or does it move?

• What type of pain is it—sharp, shooting, dull, aching?

• What is the intensity of the pain—mild, moderate, severe?

• When does the pain start and end—does it last for hours or come and go quickly?

• What makes the pain worse?

• What makes the pain better?

"This type of list is especially important if it’s difficult for you to talk about your pain and your doctor is short on time," Dr. Dews says. When a physician feels rushed—for example, when several patients are waiting in the examination room—you may end up feeling that your doctor didn’t spend enough time with you. "You can save perhaps 10 minutes by having everything on paper, rather than making your doctor pull the information out of you. Then he can focus more on treating you appropriately."