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Twenty-eight million women in the United States suffer from chronic pain. 70% of patients seeking treatment for chronic pain are women, and are found to return to pain clinics thirty-two times more frequently than men. These findings indicate that women experience insuficient pain relief following intervention. Given that 80% of pain research has been conducted on men, most knowledge of pain pathways in women are extrapolations, shedding light on the ineficiencies of current treatment algorithms, and the importance of a sex and gender-based approach to chronic pain.

The biochemistry and physiology of the pain pathway, as well as the pharmacokinetics and pharmacodynamics of medications used to remedy pain responses, are signifcantly different between men and women. Low-estradiol states result in a reduction in both mu-opioid receptor recruitment and basal activation, leading to significant hyperalgesia and sensitivity to chronic pain in women as compared to men. Further compounding the dichotomy between the chronic pain response is the response to analgesics. Women have lower levels of glucuronidation, higher volumes of distribution, and lower clearance of commonly administered analgesics as compared to men. Psychosocial factors such as gender roles, expectations surrounding pain, and coping strategies also determine how pain is perceived and ultimately influence how pain is treated. These findings are just beginning to shed light on the ways in which women and men respond differently in vivo to pain. However, the decision to treat women and men as separate entities with respect to pain management should not be a binary one. While patients should be treated as individuals, pre-menopausal, post-menopausal and transgender women, should all be met with an approach that takes into account the sex and gender differences that exist. Pain management physicians should take heed of these complex differences and utilize a sex and gender-based approach while managing patients.

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nesthesia, anesthesiology, pain management, sex and gender, interventional pain

Chronic pain: the importance of a sex and gender-based approach to treatment