The pain divide between men and women.

The problem with treating pain, of course, is that no one can see it. And even though doctors are warned never to think that they know how much pain patients are experiencing, it happens all the time. “Put yourself in that position and you immediately misrepresent the patient and do them a misservice. The patient may end up undertreated,” said Allan I. Basbaum, PhD, professor and chair of the Department of Anatomy at University of California, San Francisco, and editor in chief of the journal Pain. Women are particularly likely to face this problem because they seek treatment for pain far more often than men. In fact, clinical pain conditions, except for back pain, occur at far higher rates in women, Basbaum said. For instance, 9 of 10 patients with fibromyalgia and 8 of 10 patients with temporomandibular disorder are women. Women are also 2 times more likely to have irritable bowel syndrome (IBS), 9 times more likely to have interstitial cystitis, and 3 times more likely to have migraine. Exactly why women experience pain differently from men remains largely unclear. “However many people you talk to, that’s how many explanations you will get. A variety of factors probably contributes to the sex differences in pain,” said Roger B. Fillingim, PhD, associate professor at University of Florida College of Dentistry in Gainesville. Some pain experts postulate that the differences originated during primitive times when gender roles were more clear-cut and people’s response to pain was more closely linked to survival strategies. Societal, behavioral, and psychological influences still clearly play a part in sex differences in pain. For a long time, doctors tended to undertreat women’s pain, chalking up their symptoms of pain to their being more emotional or lacking in toughness, but recent clinical studies, backed by abundant animal studies, have demonstrated that women have a lower threshold and tolerance for pain. Currently, researchers are beginning to identify specific biological underpinnings of sex differences in pain. These findings are providing clues about why women suffer more and, in doing so, are making women’s reports of pain more difficult for physicians to dismiss. Continued research in this direction may lead to a day when doctors treat pain in both female and male patients more effectively.