Summary: Women are more likely to have chronic pain. A new study shows this is due to genetic differences. These genes make women prone to changes in nerve pathways and to neuroinflammation (inflammation in the nervous system). Women are more likely to seek care for conditions like migraine and fibromyalgia. But they also face gender bias, when many providers fail to see how severe their condition is.
Women are more likely to have chronic pain. This is true even though some common painful conditions are just as common in both sexes. For example, osteoarthritis rates are about the same in men and women. Yet women are more likely to develop chronic pain and to respond poorly to therapy. Also, chronic pain from conditions with no visible physical changes, like migraine and fibromyalgia, is much more common in women.
Chronic pain means some women are always seeking treatment. But this also leads to a lot of gender bias in health care. Sometimes doctors think the pain comes from mental issues. Now a new study in the journal PLOS Genetics suggests the differences between the sexes come from genes. So women are more prone to problems like neuroinflammation, and so to chronic pain.
Many chronic pain conditions in women are hard to study. Conditions like fibromyalgia or migraine have no reliable biomarkers (lab signs that prove a disease). How these conditions develop is also poorly understood. Still, doctors know that something is happening in the female body that they cannot trace. After all, a missing biomarker does not mean nothing is wrong.
What did the genetic study find about chronic pain in women?
Luckily, technology and big data now let us study many things, like small genetic differences between groups of people. For example, researchers can now use genome-wide association studies (GWAS). These show which genes are more likely to be tied to certain health conditions. GWAS studies use huge datasets. For example, they might compare the genes of half a million people without a condition to the genes of 100,000 people with that disease.
These studies use computers and complex software to find genes tied to certain disorders. They became possible thanks to huge genetic datasets and faster computers. In this study, researchers compared gene variants tied to chronic pain in 209,00 women with 178,000 men. These people lived with chronic pain and gave their genetic data to the UK Biobank.
The researchers found 37 genes in men, and 30 genes in women, tied to how pain signals travel from the spinal cord to the brain. These different gene sets suggest that female genetics can explain why women are more likely to have chronic pain.
There was a reason the researchers focused on how pain signals travel. Studies show chronic pain is different from short-term pain. In chronic pain, the problem is changes in the pathways that carry pain signals. Where the pain started matters less. These changed pathways turn up the pain. That causes severe chronic pain, even though doctors may see few changes in the body. In many cases, the disease that first caused the pain may be almost cured.
But genetic differences make women more likely to have this problem. They are more likely to develop neuroinflammation, which makes pain stronger and longer lasting. Doctors say these findings matter because they can help fight gender bias. For example, in one study, people were shown videos of men and women in pain. Most rated the men’s pain higher than the women’s. They were less likely to take women’s chronic pain seriously.
Frequently asked questions
Why is chronic pain more common in women?
Genetics is a large part of the answer. A study in PLOS Genetics compared UK Biobank genetic data from women and men with chronic pain. It found different sets of genes — 30 in women and 37 in men — tied to how pain signals travel from the spinal cord to the brain. Women are also more prone to neuroinflammation, which makes pain stronger and longer lasting.
Why isn’t women’s pain taken seriously?
Gender bias. Many conditions that hit women hardest, like migraine and fibromyalgia, show no visible physical changes. They have no reliable biomarkers. So doctors sometimes assume the cause is mental. In one study, people shown videos of men and women in pain rated the men’s pain higher. A missing biomarker does not mean nothing is wrong. The genetic findings help make that case.
What does chronic pain do to a person?
Chronic pain changes the nervous system itself. Unlike short-term pain, the problem sits in the pathways that carry pain signals to the brain. It is not at the spot where the pain started. Those pathways begin to turn up the pain. So a person can hurt badly even when doctors see few changes in the body. This can happen even after the first disease is almost cured.
Is fibromyalgia more common in women?
Yes. Fibromyalgia and migraine are painful conditions with no visible physical changes. They are much more common in women, and women more often seek care for them. That is not true of every painful condition. Osteoarthritis occurs at about the same rate in both sexes. Yet even there, women are more likely to develop chronic pain and to respond poorly to therapy.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
