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Researchers are discovering physical and emotional differences
in the ways men and women cope with pain by Bob Roehr
Just off Hawthorne
S
ex is Mother Nature’s biggest experi­
ment,” says Karen J. Berkley, a neuro­
scientist
from
Florida
State
University. “It affects absolutely every
aspect of our lives, ranging from
genetic to molecular, to physiological, to cellu­
lar, to psychological, to socio-cultural issues.
And at every different level, from metabolism to
structural differences, including the brain.”
Berkley made those remarks during a
National Institutes of Health conference enti­
tled Gender and Pain: A Focus on How Pain
Impacts Women Differently Than Men, held in
the nation’s capital in early April.
Women generally have a lower pain thresh­
old than men and are more willing to acknowl­
edge pain, according to some research.
“At some levels, what women are doing is
recognizing a problem earlier, which gives them
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Caren J. Berkley
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nonopioid system only seems to be present in
male mice. There are indications of a parallel
but different system unique to females.
Dr. William Isenberg evaluated gender and
pain in rats at the University of California San
Francisco. He found that injecting opposite-sex
hormones in males and females would reverse
their thresholds of pain to reflect the gender of
the hormone injection. Refining the work, he
was able to reduce dosages and localize the effect
so that sensitivity to pressure in one paw was
“male” while the other remained “female."
This gender bending of rat paws has some
profound implications. One is that it indicates
regional-level “receptors for hormones that are
active in the peripheral nerves to moderate neu­
ron function.” That is, not all pain is processed
in the brain; there is some local autonomy in the
nervous systems, which opens up the possibility
of using nonmorphine-based pain
blockers at a localized level. Those types
of drugs are likely to be safer, with fewer
side effects.
Francis Keefe studies osteoarthritis
at O hio University. T he disease affects
40 percent of middle-aged adults and 70
percent of older adults. Its most com­
mon symptom is pain.
But why do two individuals with the
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for
and
more of a means to deal with it. So with
greater vulnerability comes greater
strength,” says Berkley.
The hormone estrogen regulates a
woman’s monthly fertility cycle during
the period from puberty to menopause.
But science is increasingly uncovering
ways that estrogen affects other body
functions.
Bruce McEwen, a neuroendocrinol­ Francis Keefe
same degree of disease severity report quite dif­
ogist at Rockefeller University in New York,
ferent levels of pain?
says the very wiring of the brain’s circuitry “is
“One may he confined to a wheelchair while
subtly influenced by the process of sexual differ­
entiation” in the developing fetus.
the other is out walking the golf course every
Male and female brains each have nearly the
day,” Keefe marvels.
same number of receptors for estrogen and the
So he asked his patients to keep a diary not­
male hormone androgen, he explains.
ing their level of pain and how they coped, and
mail it in at the end of each day.
“And yet there are numerous examples
“Women reported 40 percent more pain.
where giving estrogen to a male does not do the
They were much more prone to use emotional-
same thing to his brain as giving it to a female.
focused coping strategies to help them deal with
And giving androgen to a female brain does not
do the same thing as giving it to a male,”
the pain,” he says.
McEwen adds.
These coping skills seemed to help them get
Differences in nerve synapses and serotonin
beyond the pain and have a smaller spillover
receptors have also been found in male and
effect into the next day. Men, meanwhile, tend­
female spinal cords. All of these differences
ed to cany pain over a longer period of time.
affect the way people’s bodies make connections
“Men have a lesson to learn here, particular­
and process sensory information.
ly in the utility of active coping approaches,”
Jeffrey Mogil, a researcher at the University
says Keefe. “It could well be that increasing the
of Illinois, says most of the gender differences
frequency of coping, particularly the strategies
related to pain are “quantitative differences,”
that have to do with the regulation of emotions,
matters of degree rather than of essence.
might have some benefits for men.”
But his research has led him to believe there
Patricia McGrath, professor of pediatrics at
also is "the suggestion of qualitative sex differ­
the University of Western Ontario, says, “If peo­
ences in pain, where males and females achieve
ple don’t know that what is happening is
the same ends, but they do so using completely
painful, and you don’t express it in some way, it
separate mechanisms.”
may mean that you won’t receive good pain
Working with mice, he has isolated a “non­
control.”
opioid” receptor system that appears to be
She concludes “that parents need to help
“involved in the expression of stress-induced
children understand something that most chil­
analgesia.” It is a fight or flight mechanism that
dren learn on their own— that pain does have a
allows the body to block great pain for short
positive, protective signal. You can deal with the
periods of time.
reason for this pain and go on and resume nor­
He says the odd thing is, this particular
mal activities.”