Why Women Need a Personalized Approach to Chronic Pain Management

by Monica Mallampalli, PhD, MSc., HealthyWomen Science Advisor

When it comes to chronic pain management, no one therapy has all the answers.

Instead, chronic pain management needs to take individual differences into account and ensure an adequate and unbiased response to treatment.

To help get the conversation started on chronic pain management, HealthyWomen will convene a Chronic Pain Summit on July 17 and 18, in Ellicott City, MD. The event will feature presentations from prominent pain specialists and is designed to foster dialogue between patients, clinicians, researchers, and industry experts, and will include representatives from federal agencies and other non-profit organizations as well.

Together, we aim to raise awareness about chronic pain in women, address existing challenges and knowledge gaps, and encourage everyone to work together as we strive to find new and innovative solutions. Here is what we covered during the summit.

Addressing chronic pain as its own disease.

Chronic pain is a significant public health problem nationwide and according to a 2011 Institute of Medicine report can be considered as a disease in itself that requires adequate treatment and research commitment.

Understanding individual chronic pain needs.

Two important differences to consider when treating and researching chronic pain are sex and gender. Sex differences are influenced by both biological and physiological factors such as hormones and genetics and gender differences by societal, environmental and cultural concerns. No matter the source, sex and gender differences must be considered in chronic pain diagnosis, treatment, prevention and management.

That's because research finds women are more sensitive to pain and rate their pain higher as compared to men. Women are also more likely to have conditions that cause chronic pain—defined as lasting more than three months—such as lower back pain, knee pain (mostly osteoarthritis), neck pain, fibromyalgia, and migraines. Notably too, several painful conditions including uterine fibroids, pelvic pain, endometriosis, and vulvodynia occur exclusively in women.

Remembering that opioids are not the enemy.

Women with chronic pain conditions are more likely to be treated with opioids and use these drugs for longer periods of time than men, but even this isn't a clear-cut issue. Although long-term opioid use can open the door to addiction, many women who take these drugs responsibly worry that policy changes may result in losing access to the only treatment that has been able to ease their pain and being stigmatized as drug addicts.

We cannot take opioids away from chronic pain patients who rely on them without offering them alternatives that work.

Exploring other chronic pain management strategies.

Recent scientific evidence suggests that the use of integrative and complimentary health approaches may benefit women with managing their chronic pain with or without prescription medications.

Studies have suggested that many chronic pain patients can benefit from incorporating physical therapy, massage, exercise, acupuncture, yoga, Tai Chi, or meditation into their treatment regimen, but most healthcare professionals don't know enough about these modalities and health insurance companies rarely cover them fully, if at all. Psychological therapies, such as cognitive behavioral therapy, may also be useful, but again research, education, and access are limited.

The Department of Health and Human Services addressed these issues in a recent report and proposed best practices and recommendations for balanced pain management based on biopsychosocial model of care, individualized patient-centered care, better and safer opioid stewardship and a multidisciplinary approach to chronic pain.

Identifying biases in chronic pain management.

In the end, any approach to chronic pain must also recognize that gender, racial and cultural biases often exist in pain treatment and management. Unconscious bias by health care professionals can greatly affect the way pain is assessed, treated and managed in women, especially women of color who are less likely to receive any or adequate pain treatment.

Disability, stigma, workplace related issues, access to care and affordability of treatments are all important issues that impact pain management and the quality of life in women living with chronic pain. Whatever the reasons for these biases and these disparities, the tremendous effects on a woman's psychological health cannot be underestimated.