New review suggests solutions that can help ease chronic pain in women

Feb 26 2016

Women often suffer silently when in pain, whether it's caused by pregnancy discomfort or creaky knees. Yet there are a variety of solutions that can help relieve women of chronic pain, from exercise to identifying triggers, suggests a new review of research related to women and pain by the American Society of Anesthesiologists (ASA). This year's Women's Pain Update reveals women should not be shy in taking care of themselves, especially when it comes to daily pain.

"One of the most important take home messages from recent research is that women need to start taking better care of themselves, and stop putting themselves last," said Donna-Ann Thomas, M.D., a member of ASA's Committee on Pain Medicine, division chief of pain management and regional anesthesiology at the Yale University School of Medicine, New Haven, Conn. "This includes regular exercises to prevent or relieve pregnancy related, knee or foot pain."

Research suggests women are more likely than men to suffer from pain, and studies published in 2015 show physician anesthesiologists and other pain medicine specialists actively engaged in clinical research efforts designed to prevent or control pain. Recent studies showed that exercise can help control pregnancy related pain; explored the connection between foot pain and depression; and showed that knee pain can increase risk of death related to decreased activity. These investigations further demonstrated that a simple survey can identify women more likely to suffer from pain after hysterectomy.

Two studies connected the dots between exercise and easing pregnancy pain. A study of 39,184 women in their first pregnancy published Oct. 4 in the British Journal of Sports Medicine, found those who exercised three to five times a week before they became pregnant had a 14 percent lower risk of pelvic pain while pregnant, and high-impact exercises (jogging, aerobics) led to a lower risk of pain. Another article, a review of 34 studies, which included 5,121 women, published Sept. 30 by The Cochrane Database of Systemic Reviews, suggests that exercising during pregnancy can prevent or reduce low back pain.

Other researchers suggest some types of pain may cause women to be less active, and therefore increase their risk of depression or death. In one study of 3,321 men and women published Nov. 10 in Arthritis Care & Research, researchers found that women with foot pain were three times more likely to have symptoms of depression than those without foot pain. In another study published Nov. 5 in the Annals of the Rheumatic Diseases, researchers made a connection between knee pain and increased risk of death. Over the course of the 23-year study of 1,629 women at risk for osteoarthritis, those who had knee pain were three times more likely to die (often due to cardiovascular disease) than women who didn't have knee pain.

Physician anesthesiologists are among the medical specialists who are experts in pain medicine and are at the forefront of pain research, leading the effort to identify factors that increase a woman's likelihood of experiencing pain. For example, a study of 208 women published in the May issue of Anesthesiology suggests that women with fibromyalgia and fibromyalgia-like characteristics were more likely to have greater pain following hysterectomy. Furthermore, they found that a simple survey given to women prior to undergoing hysterectomy could identify those who may have fibromyalgia-like symptoms, even if they haven't been diagnosed with the condition, and may assist doctors with better addressing post-operative pain.

"I would like to see this survey given to women having other types of surgeries as well, because it could help physician anesthesiologists discuss specific and targeted approaches to reduce or eliminate post-operative pain," said Dr. Thomas. "There are so many options that could be offered, which could include a nerve block or the use of certain types of medications before and after surgery, which could help these patients if they could be identified earlier."

Other findings in ASA's Women's Pain Update include:
•Pain is more likely to linger after abdominal hysterectomy: Women who had a vaginal hysterectomy (removal of the uterus through a small incision in the vagina) were 50 percent less likely to suffer chronic pain than those who had hysterectomy through an incision in the abdomen, according to a study which included 766 women who underwent hysterectomy published in Anesthesiology May 2015.
•Women with knee arthritis are more sensitive to certain factors, which could increase pain - when compared to men: Women had more widespread pain and were more sensitive to pain prompted by cold and pressure, according to a study of 288 people with knee arthritis that was published Oct. 5 in Arthritis Care & Research.
•Painful fibroids are common in pregnant women: More than one in 10 pregnant women have fibroids and nearly nine out of 10 of them report pain, according to a study of 4,509 women published in the Nov. 3 issue of Paediatric and Perinatal Epidemiology. Researchers found the more fibroids a woman had, the more pain she experienced during pregnancy, and that smaller fibroids caused just as much pain as larger ones.

"Increasingly, evidence highlights that patients who live with chronic pain have physiological changes in their brain, which can lead to psychological changes," said Dr. Thomas. "Many women mask their pain, which can result in bigger repercussions than they realize, such as making them less healthy and even shortening their lives. This is why ongoing research on women in pain is so important."

Just as there are physicians who specialize in treating conditions such as cancer, heart disease or allergies, there are specialists trained to focus in the management and treatment of pain. These physicians complete four years of medical school and further training in a specialty, such as anesthesiology, physical medicine and rehabilitation, psychiatry, neurology or internal medicine, followed by one to two years of fellowship training in order to become an expert in chronic pain. Women seeking pain relief from a specialist can confirm that the physician is certified in pain medicine by an American Board of Medical Specialties recognized board, such as the American Board of Anesthesiology.

Source: American Society of Anesthesiologists (ASA)