Judy Foreman, author of the new book “A Nation in Pain” recently talked with Gary Rosen of wsj.com about America’s chronic pain epidemic and why women suffer disproportionately.

Foreman says she was “inducted, apparently, into the growing army of American adults living in chronic pain.” Several years back her neck went “bonkers” when bone spurs and an arthritic problem were most likely exacerbated by too many hours hunched over a laptop.

She discovered that there are 100 million Americans suffering from chronic pain, according to the Institute of Medicine. She also found out that a disproportionate number of them are women.

What is clear in her findings is that women and men react so differently to both pain and pain medications that, McGill University pain geneticist Jeffrey Mogil says, half-jokingly, “we may someday have pink pills for women and blue pills for men.”

Historically, women have been shown to be more sensitive to experimental stimuli – with lower pain thresholds, and lower tolerance. More recently, research shows that the type of pain stimulus – heat, cold, mechanical pressure, electrical stimulation makes a big difference in attempting to understand gender differences.

Clinically, women are more likely to get chronic painful conditions that can afflict either sex and are more likely to report greater pain then men with the same condition. In 2008, researchers looked at prevalence rates in several developed and developing countries. In a sample of 85,000 people, they found that the prevalence of any chronic pain condition was 45% among women, versus 31% among men. In a 2009 review, University of Florida researchers found that all over the world, women get more fibromyalgia, more headaches (especially migraines), more osteoarthritis, and more jaw problems such as TMJ, (now called TMD) as well as more back pain.

As young children, boys and girls show comparable patterns of pain – until puberty. Once puberty hits, some types of pain are much more common in girls. Foreman says that even when the prevalence of a pain problem is the same in both sexes, pain severity is often more intense in girls. This is especially true with migraines. Before puberty, boys and girls get about the same number. After puberty, the prevalence becomes 18% for women and 6% or 7% for men.

And, many researchers believe testosterone and estrogen play a role in pain, with testosterone acting as a protection against pain far better than estrogen.

So where does this leave women in pain? Foreman says in the same boat as men in pain. Both sexes often have to be persistent in the search for a doctor who can help them with their suffering. When Foreman began looking for a doctor to help her with her neck pain, the first doctor she saw implied there was an emotional trigger for her pain. She felt like insult had been added to injury. She left that doctor and found another – who believed her and set her on a path of treatment that ultimately worked for her…… wsj.com     1/13/14



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