Science, Weeklies

She’s Such A Pain

A new study shows that women feel pain more intensely than men do.

From headaches, to stubbed toes, to sore throats, people experience pain all the time and at various intensities. You probably know some people who deal well with pain and others who cannot handle even the smallest amount of it. Now a new study indicates that there may be a gender difference in pain sensation.

“I feel like this should be surprising, but it really isn’t,” said Riddhi Parikh, a sophomore in Sargent College. “I think women are emotionally stronger, but men probably experience less physical pain.”

A study recently published in the Journal of Pain, shows that women report feeling pain more intensely than men.

“We aimed to settle once and for all this fight that there is a difference between men and women when they report pain,” Dr. David Ruau, a postdoctoral student at Stanford University School of Medicine and first author of the study, said in a telephone interview.

The researchers at Stanford University School of Medicine probed into the electronic medical records of 11,000 patients in order to draw their conclusions

“This highlights the potential of electronic medical records to conduct large-scale pain studies. Our results are consistent with previous studies reporting pain differences between sexes and also suggest that clinicians should pay increased attention to this idea,” the authors of the study said in Pain.

PROBING PAIN

The authors explained that before this research, many studies had shown that women suffer pain more often, but the results of these were not consistent. The researchers thus decided to use the clinically recorded pain scores from patient health records in order to study the reported pain of patients when they discovered that there was a gender difference in pain perception.

            “We were studying differences within the population in pain. When we were looking at the data we discovered that there is a huge difference between men and women,” Ruau said.

Ruau explains that every time a patient goes to the hospital, they have to record their pain levels on a scale of 0-10.

“This is a subjective measure because there is no way to objectively measure pain,” he said.

The researchers used de-identified medical records for 72,000 patients to analyze over 160,000 pain scores in 250 primary diagnoses, according to the study in Pain.  They analyzed the data on a disease-by-disease basis and deduced the differences in genders from these.

They found the most differences in disorders of the musculoskeletal, circulatory, respiratory and digestive systems. Sex differences were also reported in infectious diseases, injury and poisoning. Additionally, new diseases were found in which pain levels differed such as acute sinusitis, according to Ruau.

“People have known there were differences in pain between the sexes before.  However, they did not know that it was present across all diseases like we found,” Ruau said.

Another reason this research is so different is because of the large scale on which it studied pain. Ruau notes that no study has been done with so many patient records—11,000 in this case.

“The breadth of the study is in fact overcoming the difficulties of drawing a final conclusion—because we have so many records we can deduce a relatively strong conclusion,” he said.

MEN ARE FROM MARS, WOMEN ARE FROM VENUS

Despite the results of the study, the researchers are unable to say anything about the reasons behind the difference in pain beyond what is already known.

“We already know there is a physiological difference at the hormonal level between men and women. Estrogen increases the pain threshold for women and influences their pain rating. This factor doesn’t exist in men,” Ruau said.

Ruau also suggests that genetic differences may also account for pain differences in a population. Students agree with this possibility.

“I feel like men’s bodies are built to handle pain. I would think there’s an evolutionary difference between men and women in pain perception,” Parikh said.

Some students feel that the difference may trace back to the early days of mankind.

“Early on men were hunters and the survival of a community depended on them.  Men therefore could not afford to feel intense pain because it could hinder their performance,” said Alexa Dierech, a sophomore in the College of Arts and Sciences. “Since women were not assigned such a physically demanding task, they were not forced into situations that would cause them to match their pain scale to a man’s.”

Dierich also believes that differences in pain perception may have to do with the brain.

“Maybe men and women feel pain in the same in a physical sense, but women deal with it in different neurological ways,” she said.

Ruau noted that the researchers goal is to raise differences in the medical community about pain differences and to educate the public that there are differences.

“These differences are important to study because many drugs in development do not consider in their strategy plan to study differences between men and women. Men and women are really different at the hormonal level it is important to include them in research,” he said.

Ruau further pointed out that 85% of research publications do not report gender differences in their studies. If groups ignore the difference between men and women, they may not know how the drug will be processed by each sex and the drug might work differently in men and women.

“I think drug companies should create drugs to deal with the differences in gender,” said Rishitha Bollam, a sophomore in CAS. “If it helps women to better cope with their pain and allows for a quicker recovery, then different drugs need to be catered for men and women.”

RESEARCH RESTRICTIONS

There were some limitations to studying electronic medical records, however.  For one, the researchers were not able to know if the patient had taken over the counter analgesics before coming to the hospital.

“If a patient takes acetaminophen (e.g. Tylenol) before coming to the hospital, he already has medicine in his blood so his pain level will be reduced. We could not access this information about what happened before the hospital visit,” Ruau said.

The researchers tried to control this drawback as much as possible by taking only the first pain score of an encounter with a patient into account.

Additionally, there was the psychological effect that they were unable to account for. Ruau suspected that pain scores might have been different depending on the gender of the treating physician or nurse.

“The interaction between who asks the question and what answer is given can be different. A man in front of a nurse may rate his pain lower than he would in front of someone else,” Ruau said.

The researchers tried to control this bias by collecting a huge number of pain scores. The larger the number, the closer to the truth and less bias statistically.

PROBING FURTHER

 The researchers believe that the next step in their study will be to investigate for a physiological biomarker of pain—some sort of lab test such as a blood test that can give an objective measure of pain.

According to Ruau, if pain can be measured objectively, it will be easier to treat patients. For example, more accurate prescriptions could be given if pain is measured objectively.

Until then, however, pain remains a complex issue for scientists everywhere.

“Pain is a perception, and as such it represents a complex issue,” said Dr. Vincent Dionne, a biology professor at Boston University. “There are psychological, hormonal, and cultural aspects to pain, but precisely how those features interact to control the intensity of perceived pain remains uncertain.”

Many also believe that encouraging the study of gender discrimination should not be seen as sexism.

“This shouldn’t be seen as downgrading women or sexual discrimination,” Bollam said. “This research has the potential to benefit the lives of millions.”

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