Women and Pain: Why It Hurts and What You Can Doby Mark Allen Young, Karen Baar
--Women often exhibit different symptoms than men for the same ailments; for instance, with coronary artery disease, where men typically feel chest pain but women more frequently/em>
In Women and Pain, Dr. Mark Young shows readers how to finally end their chronic, agonizing pain. Most women -- and indeed, many health care professionals -- don't know that:
--Women often exhibit different symptoms than men for the same ailments; for instance, with coronary artery disease, where men typically feel chest pain but women more frequently report pain in the back, neck and jaw. Since most doctors are trained to look for and treat the typical male symptoms, many will misdiagnose a woman or tell her it's all in her mind -- when she is actually experiencing very serious symptoms.
--Women have both lower pain thresholds and less pain tolerance than do men -- i.e., they feel more pain.
--Certain classes of drugs work better to relieve women's pain than they do men's.
--Women may be at greater risk for pain-related disability -- in part, because of their reproductive cycles.
--Controversial new research reveals how anatomical differences between men and women may at least partially explain their distinct responses to pain.
Finally, here is an empowering and revolutionary book by a medical doctor that recognizes what many women have long known: Our pain is a uniquely female issue . . . and many of our physicians simply don't understand how to deal with it. Studies now demonstrate that women feel more pain, seek help more aggressively, and are more open to alternative treatments than men. At last, Dr. Mark Young offers women the practical and complementary solutions that other practitioners may have overlooked. Women and Pain specifically addresses a complex array of strictly female symptoms and concerns -- from childbirth and menstrual pain to fibromyalgia and osteoarthritis -- that set us apart from men.
Many women live with chronic, agonizing pain that affects every aspect of their lives. Traditional medicine can only offer drugs and surgery, but often neither is successful. Yet most women do not know of the many complementary and holistic treatments for pain that can provide great relief. Nor can they find out about alternative remedies from their doctors, who, when conventional remedies are exhausted, may dismiss pain as stress-related or "in your head." In addition, most traditional treatments are based on research that has only included men.
Not only does Dr. Young show that women respond differently to pain and require different treatments, he also provides very specific remedies, backed by scientific studies, for relieving hundreds of painful ailments. Women and Pain covers the hormonal connection to pain; bone and joint pain; muscle and nerve pain; headache; sports injuries; and chronic, unending pain. In addition to describing the traditional medicine cabinet, the author includes foods that heal; muscle strategies, such as Shiatsu and massage; herbal and botanical remedies; exercises to speed healing; mind-body therapies; and acupuncture. He even includes recipes, such as "migraine meals," for certain problems. You can use most of the remedies on your own, although you will need to consult with your doctor about others, such as traditional medicine and acupuncture.
This groundbreaking book will be welcome news to all the women who suffer from chronic pain, but who have had no lasting relief from doctors and traditional medical approaches.
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Read an Excerpt
Tell Me Where It Hurts
Do you suffer from constant, agonizing pain? Have you been to doctor after doctor, only to receive nothing that helps or be told "it's all in your head," "it's stress," or "you're just getting old"? If so, you're not alone.
Women have said it and men have denied it for years. Now we know that it's true: Women feel more pain, seek help more aggressively, and make more active attempts to cope with pain than men.
Unfortunately, we also know that too frequently women aren't taken seriously. Although we think of medicine as a professional discipline, rooted in science and free of bias, this isn't always the case. Frankly, our health care system often disregards women in pain. At best, it's ignorance of gender differences. But some physicians stereotype women as complainers who are less self-controlled and more likely to overreport symptoms than men. They dismiss female patients with antidepressants, antianxiety drugs, and platitudes. This adds insult to injury. When you're in pain, it's the last thing you need.
Given how much we know about pain, it's scandalous that women suffer needlessly. As a physiatrist, a physician board certified in physical medicine and rehabilitation, I specialize in treating disabling painful conditions with gentle, simple conservative modalities. Using my skills in acupuncture and complementary medicine, I have helped thousands of people find relief from pain. My background as a member of the teaching faculty of Johns Hopkins University has instilled in me a strong commitment to patient education and empowerment. Since my specialty places so much emphasis on properly balancing the emotional and physical needs of patients, often people with painful chronic disabilities, I am keenly aware of the frustration, anger, and depression that many women patients face when they are in pain and don't know where to turn for help.
Irene is a sixty-four-year-old woman who works as a stadium vendor, selling pretzels at the local ballpark. She spends most of her workday on her feet.
She came in to see me complaining of a dull ache in her right heel, along with pain, swelling, and decreased movement in her knee. She'd had discomfort for a while, but the pain was becoming considerably more disabling. Although she had developed a mild limp, that wasn't the worst of it: "Doc, at the end of the day, my foot feels like it's about to fall off and my knee hurts like the dickens."
Irene was feeling desperate. She had been to a couple of other doctors and had gotten little relief. But something else was also eating away at her: "They keep telling me that it's just because I'm getting old, and they say I have to quit my job. But I love my work; it's so much fun to be out there, especially when the Orioles win! Besides, I need the money," she confided.
When I examined Irene, I discovered that she had a large heel spur and an osteoarthritic knee. I knew right away that we could come up with a plan that would relieve her pain and let her keep working.
Irene usually wore the same shoes day in and day out, a pair of worn-out espadrilles she picked up at Payless. I told her she needed to invest in comfortable, cushioned sneakers to wear at work. I also recommended that she buy a viscoelastic horseshoe-shaped heel cushion (which allows the spur to "float" without direct contact) and to think about getting fitted for custom-made orthotics. It was essential that she provide some padding for that heel. Also, what goes on in your foot affects the rest of your leg, so good footwear would also have a positive impact on her arthritic knee.
In addition, I suggested that she soak her feet in an herbal bath after work each day. She laughed when I suggested that her husband learn the arts of foot massage and acupressure, but she took the handouts and put them in her purse.
For her knee, I suggested glucosamine and chondroitin supplements, two nutritional remedies that effectively relieve osteoarthritis. I also showed her how to do quadriceps strengthening exercises to bolster the stability of her knee joint, and urged her to add some light aerobic exercise to her daily routine.
I ran into Irene the next time I went to a game. She was in the next section of the stadium, but when she spotted me, she flashed a big smile and gave me a thumbs-up. After the game, she caught up with me. "The pain is so much better, Doc, and my limp is gone." Then, she winked and said: "And those foot massages are great!"
Happily, times are changing. Gender has become a "hot button" issue on the national research agenda, so important that a conference on gender and pain was held at the National Institutes of Health (NIH) in 1998. Eye-opening biomedical research presented there concluded that:
Women experience more pain than men.
Women discuss pain more than men.
Women cope better with pain than men.
Society's attitudes toward men and women in pain may influence physicians' treatment.
The open expression of pain sometimes helps people obtain better pain control, but being seen as "too emotional" may work against a woman and lead to inadequate care.
Pain treatment that works for one sex may not work as well, or at all, for the other.
Some of the most galvanizing research concerns the medications we use to treat pain. This work calls into question the age-old pain management practice of "one size (or one drug) fits all." For example, a series of landmark studies has shown that morphine-like drugs, called kappa-opioids, produce significantly greater pain relief in women than in men. (These drugs work through receptors in the central nervous system. There are multiple types of opioid receptors kappa, mu, delta, and sigma. The mu and kappa categories are the two major classes thought to be responsible for analgesia.) Kappa-opioids are not as commonly used as other narcotic pain medications. Drugs that work on the mu-receptors are the standard of care and are much more frequently prescribed. Yet they cause more nausea, itching, cardiac effects, constipation, and depression of the respiratory system. Treating women with kappa-opioids, then, may provide better pain relief with fewer side effects. Other studies show that common pain relievers do less for women than for men. For example, in a recent study of experimentally induced pain, ibuprofen the key ingredient in Advil, Motrin, and other over-the-counter analgesics known as NSAIDS (for nonsteroidal anti-inflammatory drugs) was less effective at providing pain relief for women than men. Perhaps dosages for NSAIDS need to take gender into account.
In addition, many painful diseases and injuries disproportionately affect women. Even when men and women suffer from the same illness, the symptoms may be different:
Osteoarthritis (OA), or degenerative joint disease, is far more common among women over the age of fifty-five, and women may suffer from a more severe form of this disease. In one recent study, women experienced 40 percent more pain, as well as worse pain. In addition, women are more likely to develop inflammatory types of OA that lead to knobby deformities of the DIP and PIP joints (the two sets of joints below the knuckles).
Rheumatoid arthritis (RA) occurs two and a half times more often among women, and it may also affect them more severely. Women have reported more painful joints, more swollen joints, and worse function. And the majority of studies show that RA is slightly more disabling for women than it is for men.
Migraine headaches are more severe, longer lasting, and more frequent in women than in men. In addition, women have more nausea, vomiting, numbness, and tingling with their headaches, while men are more likely to have a visual aura. Tension headaches occur two to three times more frequently among women, who also experience much higher levels of tenderness in all the muscles surrounding the skull.
Women athletes experience knee injuries two to eight times more frequently than their male counterparts. This is particularly true for tears of the anterior cruciate ligament (ACL).
Osteoporosis affects both sexes, but women develop it at a much younger age and in far greater numbers because of hormonal differences.
Gender differences play out on the operating table, too. In a study recently published in the British Medical Journal, women emerged from general anesthesia faster than men. However, they returned to their presurgery health status significantly more slowly and they experienced more postoperative complications.
Women Aren't Just Small Men
We don't know why these differences exist, but a wide range of scientific studies shows that the sexes differ on nearly every level. From the molecular to the psychological, from the basic genetic codes to the hormones, biology, physiology, and the overall functioning of the immune response systems men and women are different.
We aren't doing enough to understand and close this gender gap. The prestigious Institute of Medicine (IOM) of the National Academy of Sciences recently issued a call for biomedical researchers to "study sex differences from womb to tomb." The IOM's report recommended that researchers take sex differences into account in clinical trials, including studies of new drugs.
Even when women participate in clinical trials and more women do now than five years ago there is little gender-specific information coming out of the studies. Scientists at drug companies and research institutions have largely ignored sex-based differences in their data analysis.
We also know precious little about how drugs behave during pregnancy or breast-feeding. Most women who participate in research are postmenopausal. Admittedly, there are serious ethical concerns about allowing women of childbearing age to enter studies. But there may be other, less worthy issues at stake: Perhaps pharmaceutical companies are worried about the marketing consequences of defining a drug as more effective in one sex than another.
Sticking our heads in the sand is not the answer. We must develop guidelines that allow all women to fully participate in research. Failure to do this has serious ramifications; it could, in fact, be a matter of life and death. For example, of the ten prescription drugs withdrawn by the FDA from the market since 1997 because of adverse reactions, eight posed greater risks for women than for men. (In some cases, the drugs were more widely prescribed to women; however, even with medications prescribed equally to males and females, they were more dangerous for women.) And when you are pregnant, physiological changes may affect your response to a drug; you may be more vulnerable to its toxicity or its effectiveness. When you take a drug, you need to know that it is safe and effective for you.
Copyright © 2002 Mark Young, M.D., F.A.C.P.
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