Female vulnerability to pain and the strength to deal with it

Abstract

Sex is one of biology's, that is, life's most potent experimental variables. So, are there sex differences in pain? And are these sex differences applicable clinically? The answer to both questions is decidedly yes, of course. But we still have a long way to go. We have much to learn from the study of females, making use of the lifelong changes in their reproductive conditions as experimental variables. We also have much to learn from animals, especially if we apply what we know about their social lives. However, the challenge in all of these studies is not first to look for some mythical neurological entity called pain experience and then to learn how sex modulates it, but rather to seek to understand the rules by which sex influences all of biology's mutually modulatory factors – social, psychological, physiological, cellular, molecular, and genetic – that collectively create the motivating circumstances we designate as pain. It appears almost beyond doubt that on the one hand these factors interact to make women more vulnerable to these circumstances than men, but on the other hand that women have more varied mechanisms for balance. Happily, the details of these sex differences at all levels biological (social to genetic) are now emerging in a rapidly growing body of literature that promises new insights into and applications for the individual person, male or female, in persistent pain.