Article on Women and Chronic Pain

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From the publication Practical Pain Management

http://www.ppmjournal.com/abstract.asp?articleid=P0407F07

Women and Chronic Pain

by A. Yount, DDS, FAGD

Neuromuscular problems (neck, back, and head pain) are the second most

common pain next to viral- and bacterial-induced pain. Pain in the cervical=

masticatory muscles (head pain) is one of the most common problems for

females.1 In double-blind, randomized studies, the female-to-male ratio is =

3-

to-1 for chronic pain in most of the major head and neck pathologies.

However, the actual number of women seeking care is closer to 10-to-1, or

even as high as 15-to-1 for some chronic pain clinics. In 2001, the ratio o=

f

females-to-males requesting examination at Raleigh Facial Pain Services

was 84% and in 2002 it was 80%. The exact reasons for this predisposition

are difficult to research due to its multiple causes—hormonal influences,

central sensitization (rewiring), and sympathetic system changes.

Increasingly, research is linking chronic pain to gender. The study of chro=

nic

muscle syndromes, such as myofascial pain, jaw joint pathologies,2

dysfunction,3 atypical odontalgia,4 Meniere's disease,5 Lupus,6 burning

mouth,7 and cervical dysfunction,8 all reveal a strong female pre-dispositi=

on.

Some 86% of female chronic pain sufferers in a Swedish study were found to =

clench or grind their teeth.9 Tension headache also has a female

predominance with 46% of females having frequent tension headache

compare to males at 38%.10 Nearly all the chronic pain syndromes, such as

chronic fatigue syndrome, fibromyalgia,11 and certain malignancies, have a =

female predominance.12 Migraines affect 18% of females while only 6% of

males.13 Menstrual migraine is reportedly associated with estrogen fluxes

with many of these migraines but typically resolves at menopause.14

There are currently three theories for women's predisposition to pain:

1) hormonal differences,

2) rewiring of the nervous system,

3) sympathetic issues.

Hormonal Reasons for Pain

For many years, it has been found that hormone replacement therapy

exacerbates migraines.15 Oral contraceptives change the character and

frequency of migraines.14 In the presence of estrogen, there is a heightene=

d

response to neural injury.16 Mechanical sensitivity of masticatory muscles =

increases with ovarian hormone fluctuations.2 In 60% of migraine sufferers,=

the headache worsens around the premenstrual phase of the menstrual

cycle.18 Fourteen percent of women with migraine experience headache only

with the menses.18 Most women see changes in their headache frequency at

puberty and menopause.19 These numbers provide an obvious relationship

between estrogen and chronic pain. Only recently have these pieces of the

puzzle about the pathophysiology of women's hormones and headache

relationship begun to make sense.

Please refer to the Jul/Aug 2004 issue for the complete text.