17 Mar 2011
Chronic pain is more common in women, but some still do not get treated,
Mrs Elizabeth Chew had lower back pain for more than 10 years before she decided to see a doctor for it. And that was only because she could not get out of bed one day.
The retiree, in her late 50s and a mother of one, said: "I had no time to see a doctor as I was busy with work and family. I just kept popping painkillers."
She was diagnosed with arthritis of the lumbar facet joints, which connect the bones of the spine. The pain subsided after she went through a procedure in 2009 at the KK Women's and Children's Hospital (KKH) in which a radiofrequency current was used to produce heat to disrupt nerves carrying pain signals to the brain. She had another procedure last month.
Like Mrs Chew, many women suffer chronic pain for far too long.
According to a 2008 statement by the International Association for the Study of Pain, chronic pain affects more women than men around the world, but many women remain untreated.
Dr Sandeep Kulkarni, a consultant from KKH Women's Pain Centre, said this could be due to the multiple roles women play, as home makers and workers.
He said: "Women may suffer silently due to social, family and work issues. They just want to carry on with their lives in spite of their pain."
Living with her pain
In Singapore, nearly 11 out of every 100 women have chronic pain, compared to fewer than eight out of every 100 men, according to a study by the Pain Association of Singapore. This means about 160,000 Singaporean women may have chronic pain.
The study, published in the 2009 issue of the Annals, the journal of the Academy of Medicine, found that overall, 8.7 per cent of Singaporeans, or 359 of more than 4,000 surveyed, had suffered chronic pain in at least three of the previous six months.
KKH Women's Pain Centre treated more than 500 women last year.
When it hurts much more
It is not known why, but chronic painful conditions such as fibromyalgia, irritable bowel syndrome and migraine headaches are more common among women while men tend to be referred more for work-related injury, said Dr Tay Kwang Hui from the Pain Management Clinic at National University Hospital (NUH). The clinic saw fewer than 1,000 patients last year and about half were women.
Studies have also found that women tend to have more severe pain than men. In the Pain Association study, 3.8 per cent of the women surveyed – a total of 82 – had moderate to severe pain, compared to 2.4 per cent of men – or a total of 39.
Research is not conclusive on why women are more sensitive to pain, said Dr Jane George from the Pain Management Centre at the Singapore General Hospital.
During some brain imaging studies, the female brain shows more buzz in the portion of the brain that controls emotions when a pain stimulus is given. This could bring about negative feelings which can exacerbate the feeling of pain.
Being more sensitive
Another theory says that women are more sensitive to pain because of the hormonal fluctuations their bodies experience throughout their lives, such as the menstrual cycle, pregnancy and ageing.
For instance, studies show that when the same pain stimulus is given to women at different points in their menstrual cycles, they record different pain sensitivity and pain scores.
Perhaps because women are more in touch with their feelings, there is a popular idea that pain is all in the "woman's head", said Dr George. Older women are also told to accept pain simply as a part of ageing.
The centre saw 6,010 patients last year, of which 60 per cent were women, but this probably represented the tip of the iceberg, said Dr George.
Many women do not know there is help for their pain, she said.
Indeed, there is no need for women to suffer in silence as there are many effective treatments to help them maintain an even keel, said NUH's Dr Tay.
Most pain centres adopt a holistic approach towards pain management which includes pain medication, rehabilitation and cognitive behavioural therapy for negative emotions.
When it comes to suffering negative emotions because of pain, both men and women are vulnerable, said Dr Tay.
He added that men tend to feel anger and frustration while women get depressed and anxious. Studies overseas have shown that negative emotions can aggravate pain.
According to Dr Tay, this is where women may cope better than men, as they are more likely to express their emotions as well as to seek help.
Madam Doris Wong, for instance, did not hesitate to consult a psychiatrist when she found herself depressed and losing sleep over the chronic pain caused by her fibromyalgia, irritable bowel syndrome and degenerative spine problems.
She takes anti-depressants and sleeping pills every night and, in the day, she distracts herself from her chronic pain by cooking, gardening and watching television. She also takes part in activities at a community centre.
The 59-year-old lives with her husband, 68, and has a married son, 34. She said: "At the end of the day, nobody can help you. You have to help yourself."
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Dept of Pain Management Centre
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