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Chronic pain can be 'paralyzing' for women

By Elizabeth Landau, CNN
Women's chronic pain tends to last longer and be more intense than men's, experts say.
Women's chronic pain tends to last longer and be more intense than men's, experts say.
  • A higher proportion of women than men suffer chronic pain
  • One possible reason that women sense pain this way is hormones
  • Chronic pain patients benefit from psychological help, doctors say
  • But some chronic pain patients are resistant to mental health referrals

(CNN) -- The sensation began in Melanie Thernstrom's neck the same day she went for a long swim. It flowed down through her right shoulder to her hand, as if she had a blistering sunburn underneath her skin.

Thernstrom, 32 at the time, had a couple of doctor's appointments about it, but went along with a neurologist's suggestion that it would get better on its own.

"I felt increasingly worried, but somehow not in a way that enabled me to take further action, more in a way that paralyzed me," she said. "I think of pain like one of those sea animals that attacks you by paralyzing you first."

She's now 46, the mother of 9-month-old twins, and still dealing with the pain.

Around the world, chronic pain affects a larger proportion of women than men, said Jennifer Kelly of the Atlanta Center for Behavioral Medicine in Georgia. Doctors are finding that women have more recurrent pain and more disabilities from pain than men, she said. Kelly spoke at the convention of the American Psychological Association in San Diego, California, on Thursday.

Women's chronic pain also tends to be more intense and last longer than men's, she said. Pain-causing illnesses such as fibromyalgia, rheumatoid arthritis and irritable bowel syndrome are all more common in women than men, according to the International Association for the Study of Pain.

One possible reason that women bear this burden of pain is hormones, Kelly said. The menstrual cycle can be associated with changes in discomfort among women with chronic pain.

Pain also can have long-lasting consequences that scientists are just beginning to understand. A study in the September issue of the journal PAIN found that women who suffer menstrual cramps have significant brain structure changes compared with women who don't.. Other studies have also found abnormal brain structure changes in people with disorders such as chronic back pain and irritable bowel syndrome. Scientists do not yet know what these changes mean, or if they are reversible.

A 2008 study in the Journal of Neuroscience found that people with chronic pain have neurons firing too much in certain brain regions, which could lead to permanent damage. This may explain the repeated findings in other studies that chronic pain is linked to depression.

Women tend to focus on emotional aspects of pain, worrying about how it will affect their responsibilities, whereas men focus on the sensory aspect, Kelly said. That's why it is especially important for physicians to help women challenge their negative thoughts that make the situation worse, she said.

Thernstrom, who eventually found that she suffers from overlapping arthritic conditions, agrees that many patients with chronic pain need help changing their mind set about pain. She spent a long time feeling angry and frustrated because she was looking for a "magical cure," and despaired when interventions such as physical therapy and medications did not deliver complete, quick solutions.

"Part of what helped me was switching out the model in which I had to be pain free to be happy," Thernstrom said. "Realizing I can have some pain, just like it can be raining outside and I can be happy -- it's all a matter of what level the pain is at."

Despite men and women dealing with pain differently, doctors treat them the same for conditions such as rheumatoid arthritis, said Dr. Chaim Putterman, chief of rheumatology at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York.

"We may be doing our patients a disservice by doing it that way, and perhaps there are gender-specific influences that need to be taken into account that we're not taking into account," he said.

Melanie Thernstrom, 46, has been dealing with chronic pain for 14 years.
Melanie Thernstrom, 46, has been dealing with chronic pain for 14 years.

Psychological counseling for people with chronic pain can help patients reframe how they see their pain and manage the consequences in other areas of their lives, Kelly said.

Many studies have found a connection between depression and chronic pain, with mental stress exacerbating physical discomfort and vice versa. Depression screening should be part of any evaluation of a patient with chronic pain, Putterman said.

Some of the symptoms of fibromyalgia are akin to depression, and medications for the chronic pain condition also work as antidepressants, Putterman said. Cognitive behavioral therapy, which helps people change their thinking and behavior patterns, has also been shown to be effective for this condition.

But some chronic pain patients are resistant to mental health referrals and want treatment only for the pain itself, he said.

"You would prefer to have an organic disease than a mental disease because of the stigma that's associated with mental disease in many circles," he said.

In general, women are more dependent on their network of friends and family in dealing with chronic pain than men, who tend to handle issues more by themselves, Putterman said. In his experience, women tend to come to doctor's appointments with members of their family, whereas men tend to go alone.

Thernstrom's new book "The Pain Chronicles," on sale Tuesday, details her own journey through pain as well as a history of pain from ancient Babylon to the present. For her research for the book, she observed doctors consulting with hundreds of patients of chronic pain and then followed some of those patients for eight years as they struggled to overcome their constant discomfort.

Today, her pain interferes with her ability to pick up her children as much as she'd like; she wishes she could carry them around in a sling, for instance, but already she needs a baby sitter's help to take the twins around.

Seeking treatment for pain as early as possible is crucial, she said.

"Pain is like water damage to your house after the house collapses," pain specialist Dr. Daniel Carr told Thernstrom for her book. Thernstrom herself adds, "The time to fix it is when it's a drip."