Chronic pain is one of the most burdensome health issues we face. About one in four rural Australians is dealing with some kind of chronic pain condition and about one in three of them have what is called ‘high-impact chronic pain’. High-impact chronic pain substantially reduces quality of life. It prevents people from engaging in the activities needed to be well – both physically and mentally.
Chronic pain is the most common reason people leave the workforce early and these people will retire with up to 80 per cent less savings than their pain-free counterparts. Chronic pain costs our economy about as much as cancer and diabetes combined, with a disproportionate impact on rural and regional economies.
Women are twice as likely as men to be disabled by chronic pain. Remarkably, however, most animal research to understand ‘how pain works’ is undertaken on male, not female rats. This is important for two reasons: much of what’s learnt about pain from male rats does not improve our understanding of pain in female humans and, when it comes to the mechanisms that cause pain, men and women are different.
Sex hormones have different effects on the neural pathways that carry and process danger messages coming from the body. For example, testosterone (expressed more in men than in women) inhibits these pathways, so that exactly the same event in the tissues of the body results in a smaller danger message arriving at the brain. Differences in sex hormones also modify neural pathways inside our brains that process danger messages once they arrive and neural pathways that descend from our brain to turn down the incoming danger messages ‘at the source’. What is more, genes that are associated with increased responses to, for example, painfully hot stimuli, are more common in women than in men (and in redheads than brunettes!). It is critical to remember that all of these differences are ‘on average’, and there is great overlap between men and women on all of them.
Just as important, if not more so, are differences between men and women in a range of psychological and social markers that are critical to the production of pain. These differences include social expectations, cultural norms, sex-specific expectations, social priming and early exposure to environmental stress (such as a history of physical or psychological abuse), different coping strategies, different attitudes of healthcare professionals to men and women, and different opportunities to access health care. The list really does go on.
This disproportionate impact of chronic pain on women has been identified in Painaustralia’s recent submission to the Royal Commission into Defence and Veteran Suicide. They observe a triad of issues:
- There is a link between chronic pain, mental ill health and suicide, with suicidal behaviour two to three times more likely in people with chronic pain than it is in the general population.
- Veterans are twice as likely to experience chronic pain, with women more affected than men.
- Rurality raises the risk of chronic pain and suicide even further and veterans are more likely to live rurally.
These three issues may explain why the suicide rate is 115 per cent higher in women who have served than in the wider population.
The numbers are sobering and it is clear that more needs to be done to support people with chronic pain, about two-thirds of whom are women. The complexity of chronic pain, depression and suicidality can be overwhelming, but there are some take-home messages that are worth emphasising:
- Women are more impacted by chronic pain than men and our research and clinical efforts need to reflect this disproportionate impact.
- Exactly the same injury may well result in more intense pain, on average, in women than in men, and our research and clinical efforts need to reflect this disproportionate impact.
- There is a clear overlap between pain, depression and post-traumatic stress, and our research and clinical efforts need to reflect this overlap.
How can you help? Well, there is genuine hope in all this. Pain Revolution is a non-profit initiative aiming to reduce the burden of chronic pain on rural and regional communities through the Local Pain Educator and Learning Circles programs, which aim to build capacity locally. Pain Revolution trains and supports rurally based healthcare professionals in modern pain care. Pain Revolution gives them resources and training to teach their colleagues and their community about modern pain care.
We provide scholarships to rural health professionals and, to pay for these scholarships, we run fundraising events such as the October Go the Distance! Challenge. By setting yourself a challenge to walk, run, ride or swim, and by gathering your friends and colleagues into a team to raise some highly needed funds, you will be helping Pain Revolution take on this massive problem. Please consider getting involved – together, we can make a big difference.
Please click on this link to register: pain-revolution-go-the-distance-2022.raisely.com
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