Women suffer more pain than men but are treated less

[Guest guest]

Women suffer more pain than men but are treated less

BY SUSAN FERRARO

New York Daily News

NEW YORK — Women are not wusses. They are designed to carry and

deliver babies; the latter stage of the process is often thought to

generate the worst kind of pain. And, in most cases, they are hardy

enough to survive the ordeal and nurture their infants to adulthood.

And yet nature makes it doubly hard for women when it comes to pain:

They not only endure a lot of it, they actually feel pain more

acutely than men do.

It's not " all in their heads, " as doctors have been known to tell

women who don't get better on schedule. Women notice and complain

about pain sooner than their male counterparts.

They even react to treatments differently, benefiting more than men

from morphine-like opiates but responding less to common painkillers

like ibuprofen.

And when they do receive treatment, they're often given short-shrift.

Doctors and nurses have long tended to undertreat pain, perhaps

because some of the drugs used are addictive. But in a study of

cancer patients, women got less medication than men, says Dr. Norman

Marcus, who has a private practice at the Norman Marcus Pain

Institute in New York City.

Despite all this, women in pain cope admirably, other research shows.

That makes them heroes, not hypochondriacs or hysterics, says Dr.

Mark Young, author of " Women and Pain: Why It Hurts and What

You Can Do " (Hyperion, $24.95).

Consider Ramos, 48, a wife, mother and baby-sitter in the

Bronx, N.Y. For years, she complained of head, back and neck pain

that eventually spread to a knee. Her doctor blamed sinus problems

and migraines. " But I don't have that, none of the sinus, " Ramos

says. " So I keep complaining. I feel bad, because I have all this

pain, and he doesn't do something. " Eventually, she got a referral.

Pain specialist Dr. Paru Pandya focused on a herniated disk Ramos

had. The first medication didn't help, but a second approach —

numbing muscle injections — did. " The pain goes away in the arms, the

knee and the neck, " sighs Ramos.

" Sometimes the doctors don't refer people in time, " says Pandya. " We

see a lot of women with fibromyalgia, which is muscle aches all over.

It's horrible. The sad part is that they are not believed, not given

medication, and by the time they get to us it has affected

everything. "

That's because one pain can lead to another, as a person favoring a

knee, for example, throws a hip out. Or, says Pandya, " They start to

be depressed. Then they have two problems, which might have been

prevented. "

Often dismissed as a mere symptom, pain is in fact a $100 billion-a-

year public-health problem, counting treatments, doctor visits and

lost productivity. " In my opinion, chronic pain is a women's health

issue, " says Fillingim, a clinical psychologist and leading

women's pain researcher at the University of Florida's College of

Dentistry.

Yet pain itself remains mysterious. It is necessary to life, an early

warning when the body needs help: for burns, broken arms, sore

throats, tumors. But it's also exhausting.

" Persistent pain is garbage in the brain, " Marcus says. " It inhibits

healing. "

Our tough-it-out American ethic complicates the problem. " Society

assumes that the more pain you can take, the healthier you are, "

Fillingim says. But in some disorders, like bulimia, patients have

less pain perception. Sexual stereotyping also plays a role.

" Men are supposed to be tough, stoic and not expressive, to suck it

up and deal, but it is more socially acceptable for women to be more

expressive, " says Dr. Lebovits at the New York University Pain

Management Center.

That means their complaints may not be taken as seriously as men's.

And women have lots of pain: more headaches, arthritis and autoimmune

disease; more knee problems, even as young women, and more intestinal

trouble. They get fibromyalgia more than men and suffer more of

certain injuries. There are also female-only pains: cramps, breast

tenderness and PMS.

Then there's the estrogen factor. Experts blame hormones for a lot of

pain complaints: For example, migraines seem to strike when estrogen

is high. Making matters worse, the normal fluctuation in women's

hormones has hindered research on the subject.

" I wouldn't say... evil male scientists have maliciously ignored

women over the years, " Fillingim says. " It is just easier to study

men because (researchers) don't want to mess with hormone changes. "

Women may also be more vulnerable because they seem more susceptible

to stress, which undermines the immune system and natural,

painkilling brain chemicals.

Fortunately, nature has ways for women to cope. Sexual stimulation

raises women's pain threshold, but not men's, which means pain women

experience can be helped by sexual activity. " ' I have a headache'

is not a good excuse for (women) not having sex, " Fillingim says.

" The bottom line is that women are built differently, " says Young,

who uses alternative and conventional therapies. " Doctors need to

realize that women have different pain thermostats, that women are

not small men. "