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Gender and Pain
It is now widely believed that pain affects men and women differently. While
the sex hormones estrogen and testosterone certainly play a role in this phenomenon,
psychology and culture, too, may account at least in part for differences in
how men and women receive pain signals. For example, young children may learn
to respond to pain based on how they are treated when they experience pain.
Some children may be cuddled and comforted, while others may be encouraged to
tough it out and to dismiss their pain.
Many investigators are turning their attention to the study of gender differences
and pain. Women, many experts now agree, recover more quickly from pain, seek
help more quickly for their pain, and are less likely to allow pain to control
their lives. They also are more likely to marshal a variety of resources-coping
skills, support, and distraction-with which to deal with their pain.
Research in this area is yielding fascinating results. For example, male experimental
animals injected with estrogen, a female sex hormone, appear to have a lower
tolerance for pain-that is, the addition of estrogen appears to lower the pain
threshold. Similarly, the presence of testosterone, a male hormone, appears
to elevate tolerance for pain in female mice: the animals are simply able to
withstand pain better. Female mice deprived of estrogen during experiments react
to stress similarly to male animals. Estrogen, therefore, may act as a sort
of pain switch, turning on the ability to recognize pain.
Investigators know that males and females both have strong natural pain-killing
systems, but these systems operate differently. For example, a class of painkillers
called kappa-opioids is named after one of several opioid receptors to which
they bind, the kappa-opioid receptor, and they include the compounds nalbuphine
(NubainŽ) and butorphanol (StadolŽ). Research suggests that kappa-opioids provide
better pain relief in women.
Though not prescribed widely, kappa-opioids are currently used for relief of
labor pain and in general work best for short-term pain. Investigators are not
certain why kappa-opioids work better in women than men. Is it because a woman's
estrogen makes them work, or because a man's testosterone prevents them from
working? Or is there another explanation, such as differences between men and
women in their perception of pain? Continued research may result in a better
understanding of how pain affects women differently from men, enabling new and
better pain medications to be designed with gender in mind.
Prepared by: Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD
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