Story Highlights• Until recently, most pain research didn't consider women's hormones, physique
• Researchers finding "dramatic" gender differences in experiencing pain
• Today prevention, early intervention viewed as "absolutely critical"
• Women also more prone to conditions involving the immune system
By Melanie Haiken
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You've got achy shoulders from carrying the kids, the groceries, or your incredibly heavy handbag. You look for the right pill to pop, but what should you take? Aspirin? Ibuprofen? Or, you're about to get your period. You know you'll get killer cramps or that nasty headache any minute now, but nothing you take seems to help once the pain hits.
You're not alone: Many women have a tough time finding the right kind of relief for their pain --and for good reason: Until recently, experts hadn't actually studied women's pain specifically, and most research wasn't conducted with a woman's hormones and physique in mind. All that's changing, though.
Docs now know that to banish our aches, they must develop treatments formulated for women's bodies. What's more, researchers are also looking for -- and finding -- ways to head pain off at the pass, so those of us with chronic troubles such as migraine, fibromyalgia, or backache don't have to be hobbled by pain on a daily basis. Here, how the new research will help you live an (almost) pain-free life. (Health.com: Smart ways to banish pain )
The prevention revolution
"The old way of dealing with pain was to 'wait until it hurts enough to treat it,'" says Carol A. Foster, M.D., director of Valley Neurological Headache and Research Center in Phoenix, Arizona, and author of "Migraine: Your Questions Answered." "But in the last few years, there has been a complete turnaround. Now we know that prevention and early intervention are absolutely critical."
The new thinking has made all the difference for Carolyn Robbins of Petaluma, California, who suffers from chronic back and neck pain, the result of a spinal-disk injury combined with nerve damage from Guillain-Barre syndrome. "If you've ever had an exposed nerve in your tooth, you know what it feels like," says Robbins, who describes her pain as "electrical shocks" in her upper and lower back.
The 45-year-old mother of two doesn't wait until pain hits her full force before treating it. She now relies on a daily prevention regimen, starting with a hot shower and a double dose of ibuprofen. She swims two to three times a week for strength and mobility, and gets weekly massage and chiropractic treatments. And during those times when things get really bad, she pulls out the stronger painkillers prescribed by her doctor. "I've found that it's not a good idea to try to power through the pain, because other things start to go wrong," Robbins says. "Pain depletes your system as much as exposure to germs."
Just five years ago, a "kitchen sink" approach like Robbins' might have been pooh-poohed by pain-management types, who would have been quick to prescribe hard-core, addictive drugs such as oxycontin for such a serious condition. But now the focus has switched. "It used to be, people treated the pain and didn't always treat the underlying disease," Foster says.
The problem with such an approach, though, is that it sets up a vicious cycle of dependence. "Giving narcotic pain pills to headache patients is like giving cookies to diabetics," she adds.
So how do you break the habit of heading straight for the medicine cabinet? No matter what your source of pain, the first step is to get an accurate diagnosis and then set up an early intervention strategy with your doctor, says Neil Kirschen, M.D., president of the American Association of Orthopedic Medicine and chief of pain management at South Nassau Community Hospital in New York. "The whole goal of pain management today is to keep pain from becoming chronic," he says.
The reason? Pain actually causes the brain to fire off a stress response that, over time, makes nerves more and more sensitive -- and thus better able to telegraph intense pain to you. In other words, pain actually begets pain.
Nan Weiner, executive editor at San Francisco magazine, is a case in point. When she broke her ankle eight years ago, it never completely healed, and the pain became chronic. What should have been a relatively simple injury became an odyssey that had Weiner visiting specialists all over San Francisco. She finally found a podiatrist who "took a detective-like approach to the problem," Weiner says, by exploring and treating each joint and tendon in a methodical search for the pain's source. Thanks to this care, which includes regular pain-preventing cortisone shots, the 55-year-old mother of one has been able to resume her hobby of salsa dancing.
Zooming in on female pain
We know that men don't suffer menstrual pain, but that's not the only fun they're missing. "Research is uncovering very dramatic differences in how the genders experience pain," says Mark Allen Young, a professor at New York College of Podiatric Medicine and author of "Women and Pain: Why It Hurts and What You Can Do."
It all starts with hormones. There is no getting around how profoundly hormones such as estrogen and testosterone affect the central nervous system, which is responsible for perceiving and transmitting the sensation of pain. According to experts, this is one reason why conditions such as osteoarthritis, headaches, and irritable bowel syndrome strike women at much higher rates than men.
Our physical differences really matter, too. "We've only recently begun to grasp that women's body architecture is completely different from men's," Young says. Because women walk differently, for instance, they put pressure on joints, muscles, and bones in very different ways than men do. "Starting with the knees and hips and working up to the shoulders, spine, and neck, how a person walks can have a huge impact on how pain develops later in life," Young says. Just last year, one medical-implant maker finally recognized this fact by creating a knee implant just for women.
Women are also more prone to conditions involving the immune system, says Deborah Metzger, M.D., an OB-GYN and specialist in integrative pain management in Los Altos, California. Scientists have long known that women have stronger immune systems than men, she says. That strength can backfire, though, leading women to suffer from far more autoimmune disorders -- in which the immune system attacks itself -- and the host of mysterious diseases thought to sometimes result from an overreactive immune system, such as celiac disease, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, and many types of pelvic pain.
"Women tend to have hyperalert immune systems, which is good," Metzger says. "But once the immune system gets stirred up, it can turn into a feeding frenzy." The fired-up immune activity produces inflammatory chemicals that fuel all types of muscle and joint pain; it can also activate nerves in vulnerable spots like the lower back (sciatica), the head (migraines), and the pelvis (endometriosis and pelvic pain).
New relief for headaches
There's good news for women who suffer migraines -- and most other types of headaches -- which they do at twice the rate of men. Headaches are one area where the new focus on prevention can be seen in a host of treatment options, including Botox. Considered experimental just a few years ago, Botox injections (in which the botulinum toxin type A is used to paralyze specific muscles in the forehead, brow, temples, and neck) is now offered by many hospital pain clinics. Botox is also extremely effective for certain types of neck pain, such as cervical dystonia.
Another treatment that's crossing over from fringy "alternative" practitioners to mainstream pain clinics is neuromodulation, a.k.a. transcutaneous electrical nerve stimulation, or TENS. "Think of TENS as acupuncture without needles that you can wear at home," says Joseph Shurman, M.D., pioneer of a new pain-management model at Scripps Memorial Hospital in La Jolla, California, and chairman of pain management. (Take that! (for pain) )
Extremely effective for neck pain, back pain, and some kinds of headaches, the treatment involves applying electrodes to the skin to stimulate particular nerves. "Neuromodulation works by trying to change the pain message into something else," Kirschen says.
Acupuncture is also a routine part of treatment in many headache clinics; it's used in conjunction with pain medication and other treatments. Women seem to respond particularly well to this therapy, Young says. "There are certain acupuncture points that are better for women than for men," he adds.
Fighting the fatigue
In the past year, some of the biggest headlines in pain management have been about fibromyalgia (chronic bodywide pain in joints, muscles, and tendons) and CFS, two conditions that strike women at as much as six times the rate of men. After years of failing to take these conditions seriously, the Centers for Disease Control and Prevention and other groups have recently mounted aggressive public-information campaigns alerting women to the prevalence of these conditions and the importance of accurate diagnosis and treatment. Experts have also made dramatic gains in finding treatments that work by focusing on the sleep problems and physical weakness that seem to fuel these diseases. (Could painkillers be hurting your heart? )
Marly Silverman of Pompano Beach, Florida, learned she had fibromyalgia and CFS more than 10 years ago. "It felt like acid chemicals going through my veins," she says, describing the excruciating pain that forced her to quit her job as vice president of a bank after fruitlessly seeking treatment from a variety of specialists. Today, Silverman manages her pain with a plethora of remedies, including painkillers, antispasmodics (muscle relaxants), and lidocaine patches for localized pain. To speed research into these complex and mysterious illnesses, Silverman founded PANDORA, a patient advocacy and research organization that cosponsors a national conference on the latest research into these and related neuro-endocrine immune conditions.
In studying other immune-triggered conditions such as Crohn's disease -- which also affects women at two to six times the rate of men -- experts have made a similar breakthrough. Instead of treating digestive symptoms such as gas, diarrhea, and constipation (common in Crohn's and IBS), experts realized the culprit might be an underlying food sensitivity, most likely to wheat gluten, milk protein, or one of several other common allergens. What happens, integrative pain specialist Deborah Metzger says, is that an overreactive immune system protests against the irritating foods, causing systemic inflammation throughout the body. She says that in recent years she's had great success by putting patients on the Sugar Busters diet, which eliminates sugar, white flour, and other suspect foods. Metzger's advice: Find a doctor who will analyze all aspects of your lifestyle rather than just medicate pain symptoms.
How to be a good pain patient
There's no question that women aren't always taken seriously when they ask for help with a condition that doesn't have a clear-cut explanation. Just ask those with pelvic pain. Chronic pain is bad enough, but pain down there can be very difficult to describe. "I see so many patients who come in with pelvic, vulvar, ovarian, and/or lower-back pain that they've been dealing with for years, but they can't even tell exactly where the pain is coming from," Metzger says. "There are certain nerves on the abdominal wall that tend to be vulnerable spots. It takes time and patience to pinpoint what's really going on."
That's what happened to Jo Ziegler, 39, of Katonah, New York. She struggled for more than a year with lower- abdominal pain. And it wasn't until after trying a wheat- and sugar-free diet and having a colonoscopy that she visited a surgeon who made a correct hernia diagnosis. One simple outpatient procedure, and Ziegler was rid of the pain.
Often, the biggest treatment barriers women encounter are plain old stereotypes: Women are perceived as "emotional" when they try to talk about what's bothering them, says Joseph Shurman, M.D., whose wife, Gloria Shurman, Ph.D., suffers from chronic pain. "But how can you not get emotional if it hurts, and it seems like nobody will listen?" Gloria says.
The solution is to take a proactive approach, the Shurmans say, even if you need to look in the mirror and give yourself a pep talk and write down a list of symptoms or questions before you head for the doctor's office. "The most important thing is to be persistent," Gloria Shurman says. "If you're in pain, don't ever take no for an answer."
Women physically experience pain differently from the way men do, which has historically made it difficult for some women to find relief.
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