Saturday, August 14, 2010

Chronic pain can be 'paralyzing' for women -

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.

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