More than one in five U.S. adults live with chronic pain, defined as unrelenting pain that lasts longer than three months. The majority of these patients are women who are living with pain from one or more conditions such as:
- hip, back, knee, and pelvic floor pain
- osteoarthritis and rheumatoid arthritis
- irritable bowel syndrome
- endometriosis (a condition in which the uterine lining grows outside the uterus and in other areas throughout the body)
- interstitial cystitis (a chronic bladder condition)
- fibromyalgia (a chronic condition including widespread pain and tenderness, disrupted sleep, and cognitive troubles)
Women and pain
Women are more likely to experience high-impact chronic pain, pain so severe it interferes with the ability to work or enjoy life. Why do women suffer disproportionately? There are a few reasons:
- Women experience pain differently. Women feel pain more intensely than men, perhaps due to having more nerve receptors throughout the body, an increased tendency towards inflammation, and different ways of processing pain in the central nervous system.
- Women are often not believed. Medical gaslighting, a phrase used to describe the phenomenon of having one’s symptoms minimized or ignored, overwhelmingly impacts women, who leave their appointments with either Band-Aid solutions or subpar treatments. Women of color—Blacks and Asians in particular—are particularly vulnerable. They may be subject to the false belief that they should be more physically stoic or misperceived as drug-seeking.
- Poor sleep worsens pain. Women of all ages are disproportionately affected by sleep disorders—perimenopausal and postmenopausal women especially so—due to hormone-induced insomnia and night sweats or anxiety. Without refreshing sleep, you’ll wake up fatigued, which makes pain feel more acute. Bouts of insomnia are likely to precede painful flare-ups of fibromyalgia, migraine, and other pain conditions. Fractured sleep also interferes with the body’s ability to calm inflammation, further stalling efforts to heal. Poor sleep increases the risk of, or worsens existing mood disorders like anxiety and depression, keeping the pain cycle in motion. Yet pain can make sleep feel impossible.
How to move forward
Some types of pain, like migraine and endometriosis pain, tend to diminish with age as estrogen levels decrease. Other types, like arthritis and pelvic pain, increase with the wear-and-tear of age. Treatments exist, but patients first need to be believed for those treatments to be in reach.
Find your voice so you can advocate for yourself and your pain. Women need to let their doctors know they are hurting. Unfortunately, they need to be strategic in their communication so they aren’t perceived as complaining or coming across as overly emotional. (Even though they have every right to be emotional. It’s incredibly difficult to live with day after day.)
Empower yourself with information regarding your condition. When you go to your medical appointment, carry detailed notes of medications and treatments, along with list of written questions to ask your health-care provider to ensure you get the care you need.
One patient advocate I’ve worked with who lives with chronic migraine, fibromyalgia, anxiety, and depression carries a letter from her specialists stating she has these conditions whenever seeing a new provider. She shouldn’t need to, but she has learned that doing so, especially as a Black woman, ensures she is believed.
Assemble an interdisciplinary team of health-care professionals to address your pain. Possibilities include a rheumatologist, pain specialist, orthopedist, gynecologist, physical therapist, acupuncturist, psychologist, or psychiatrist. Ask friends or colleagues who’ve dealt with chronic pain for referrals, or ask your primary care physician to connect you with additional experts. Start by describing some strategies that ease your pain (e.g., medications, avoiding certain foods, exercise, meditation) to help point them in the right direction.
Take steps to reduce underlying inflammation, which may be affecting your chronic pain. Pay attention to how diet affects your pain. Some migraineurs find that wine, gluten, or dairy make their headaches flare up. Many pain sufferers experience some relief by following an anti-inflammatory
Exercise. It seems counterintuitive that moving would ease pain in the back, hip, shoulder, or knee, but exercise eases stiffness and sends healing nutrients and lubricating fluids to the affected area. (There’s a saying that describes the pain-relieving potential of physical activity: “Rest is rust, motion is lotion.”) Certain types of exercise offer specific benefits: Strength-training builds muscle to increase endurance; stretching loosens stiff joints and muscles; walking outside gets the blood flowing and helps clear the mind.
Get a handle on stress. Stress and pain go hand-in-hand. One-third of adults with arthritis have anxiety or depression, for example, and acute bouts of stress can trigger debilitating fibromyalgia flare-ups. Managing stress, even just a bit, can have a meaningful effect on how you experience life. Different techniques work for different people, so experiment with everything from meditation and guided imagery to nature walks and volunteering. If it helps get your mind off your pain, it counts.
Therapy is a tremendous asset. Two types of therapy that work well with chronic pain are cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). CBT teaches you how to reframe negative thoughts and behaviors that would otherwise intensify and fuel pain. ACT is more about separating yourself from your thoughts, accepting your situation, and focusing on what you would like to be different. Both are usually covered by insurance and should be used alongside other treatments, not instead of. Therapy can also help process trauma you’ve endured that may contribute to your continued pain.
Prioritize sleep. Tossing and turning all night can lead to a nasty cycle of heightened pain, worsened sleep, and more pain. Try to go to bed at the same time every night, ideally by 10 p.m. A regular sleep routine with a reasonable bedtime helps regulate your circadian rhythm, promoting more and better rest. Avoid or minimize the use of electronics in the hours before bed, as the blue light emitting from the screens will interfere with your ability to fall asleep. If menopause-induced insomnia or night sweats are interrupting your sleep, ask your doctor if you’re a candidate for hormone therapy.
Ensure you’re on the right type of pain medication. Women respond differently to opioids than men and are also more prone to becoming addicted to them. Ask your doctor about over-the-counter or prescription anti-inflammatory meds. Acetaminophen can be helpful for osteoarthritis and low back pain, while nonsteroidal anti-inflammatory drugs may be better for rheumatoid arthritis. Other options include muscle relaxants, antidepressants (some may help relieve chronic pain, plus they have the added bonus of easing depression and anxiety), acupuncture, and more.
Pain on the Brain