Who Handles Pain Better: Men or Women?

Well, we don’t know the answer to that, but it hasn’t stopped several  news outlets, including the Daily Mail and MSNBC, from implying that we do. Articles have popped up this week exclaiming that women experience more pain than men. However, an exploration of the original article shows that these news stories may not be completely on the mark (and, they’re not completely off the mark, either).

Sensationalist headlines and ledes aside, both the Daily Mail and MSNBC get into some good science writing, complete with caveats and expert quotes. But let’s get to the source and see what the original journal article really says. For those of you with access to The Journal of Pain (real name ““ isn’t that fantastic and mildly hilarious), here’s the link. For those of you without access, the article was published on January 12, and it was written by David Ruau, Linda Y. Liu, J. David Clark, Martin S. Angst (geez with a name like that, he had to get into pain research), and Atul J. Butte. Its title? “Sex Differences in Reported Pain Across 11,000 Patients Captured in Electronic Medical Records.” That’s a little less flashy.

And with good reason–the article had a whole lot of substance, but it understood its own limitations. The original article had 3 main points: first, medical records could be an extremely useful tool in medical and psychological research, especially research focused on pain; second, men and women self-report statistically significantly different levels of pain for the same ailments; and third, these self-reported pain differences may be due to any number of factors, and there need to be more studies, animal and human, that include both males and females and look explicitly at sex differences.

I know I am a little nutty about science, but I was sad to see only the second point really make it to press (MSNBC did mention the lack of pain research that included female animals). The lack of research in this field, especially the lack of research on female animals and women, coupled with a new resource made available through technology (electronic records) means that our understanding of pain could improve rapidly. This is exciting stuff. It’s also exciting to see scientists find a gap in their field and work to close it, both through their own research and by calling attention to that gap.

It was heartening, though, to see in each article about the study and in the study itself the acknowledgment that the differences in the self-reports of pain could come from a variety of sources. See, self-reported pain in this case was where people ranked themselves on an 11-point scale, with 0 being no pain at all and 10 being the worst pain anyone could ever imagine ever. Patients came in and when they spoke with nurses and physicians, told them where on that scale they fell. So the pain scores could be totally reflective of real pain differences between men and women, perhaps caused by genes or hormones, or they could be caused, at least in part, but gender differences in pain reporting (men may feel pressure to seem strong and stoic).

What’s great about this uncertainty is that when it is stated explicitly, it opens the doors to new, more targeted research that may be able to untangle some of these findings. This is the kind of uncertainty scientists thrive on, opening the door to new questions. It’s not a problem that the researchers don’t know why there are differences in the self-reported pain–it’d only be a problem if it was not reported correctly or at all.

9 replies on “Who Handles Pain Better: Men or Women?”

The other thing I thought of when I read that report, was that everyone I know IRL knows how to answer the pain question when you’re reporting to doctors or nurses. It all depends on what you want. Middling-high numbers get you quick admission to the ER and good drugs. Too high numbers get you disbelief. Too low numbers get you a long wait and Tylenol. Not the most accurate gauge of actual pain you’re in.

Right – if I’m in enough pain to go to hospital, it means it’s bad enough that I can’t manage it with OTC meds, or my GP can’t, and it’s probably pretty high up on that scale.

Apologies if I’ve missed it in the piece, but did the study control for the admitting conditions, or was it restricted purely to people who were attending ERs for pain management?

I am skeptical that this will be answered, and even if it *is*, there is still so much individual variation that I’m just not sure we can figure it out.

And the implications for it seem icky to me.  Like – am I a better person if I am able to handle pain better?  Am I a better person if pain hurts me more but I still manage it okay without medication?  I am specifically thinking about the moral significance that some people attach to unmedicated childbirths, and this idea that if you can do it, you are somehow superior.  Ick.  I hate that.

I hate the moral judgement attached to pain tolerance. There was a study a few years ago that said redheads usually require higher doses of anesthesia, and I was so relieved because I felt like that gave me permission to ask for extra pain meds at the dentist. I’m not a wuss, I just got shitty genes. I don’t have to bootstrap through the pain. I had zero qualms about asking for the epidural.

Also, I’ve read a few interesting things about how we teach babies to deal with pain. When boys fall down parents are more likely to tell them to be a big boy and not to cry; when girls fall down they’re more likely to swoop in to pick them up and make a big deal about making sure they’re ok. It leads to boys not wanting to admit when they’re hurt, and girls overreacting. It gets me some dirty looks on the playground because the other parents think I’m totally heartless, but I make sure not to make a big deal every time my daughter trips or gets knocked over. It worked, because mostly when she falls down she just giggles, says “Whoopsie! I fell on my butt!” and goes right back to racing around. If she’s really hurt she cries, but even that usually lasts less than a minute.

Anecdotally, I totally see the whole “redheads needs more anesthesia” thing. On one hand, my husband (who is sorta kitty-haired in that his hair is brown but his beard is red), needed a TON of anesthesia to get numb before he had a root canal. He has a fairly high tolerance for pain, but when it comes to something where anesthesia is required, it seems his body has a high threshold for that as well.

But on the flipside, my daughter who is full-on redhead flips OUT over pain. You can hardly brush her hair. She howled so much over a splinter that she scared the dog into peeing on the floor. She hates ANYTHING that will make her uncomfortable. She hasn’t had to do anything that requires anesthesia yet, but I’m sure when the time comes, she’ll be fighting that too.

My son is more of trooper when it comes to pain, but I think I’ve treated them pretty much equally in my reactions to them hurting themselves — That is, more on the end of “You’ll be fine, just give it a minute.”

But both of them are more likely to get upset over hurting themselves if they can somehow blame me, haha. If it’s something that was their own fault, they’re much more likely to brush it off and act like it didn’t happen.

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