Pain 351

Pain

Are you in a lot of pain every day? Have you had doctors tell you 

that “it’s all in your head” or “it’s just nerves”? If so, you’re not 

alone. Pain is often undertreated in women. The good news is 

that there are different ways to explain your pain so that you can 

get the help you need. There are also many things you can do to 

manage your pain and feel better.

The truth about pain

Pain is a regular, if unwelcome, reality for 

many women, perhaps even more than 

it is for men. Most women have pain 

with menstruation at some point in their 

lives, and childbirth can be painful. Some 

common disorders of the female reproductive tract are painful. Also, painful 

autoimmune (aw-toh-ih-MYOON) diseases are much more common in women. 

To cope with their pain, women tend to 

use more approaches than men, such as 

learning about their condition, turning to 

others for support, and finding ways to 

relax more and manage stress.

Still, it can be hard for a woman to get 

help for her pain. Some doctors are less 

likely to give women painkillers because 

they think that women overstate the 

amount of pain they feel. Studies have 

shown that given the same amount of 

pain, men are less likely to report it than 

women. Men might feel they need to 

“tough it out.” But this doesn’t mean that 

the pain women are reporting isn’t real.

Chronic pain

Women are more likely to have chronic 

pain conditions. Pain is chronic if it lasts 

more than 3 months. Chronic pain can 

sometimes last years or even decades. 

Sometimes, pain is caused by injury or 

disease. In such cases lab tests show definite signs of injury or disease in an organ 

or other body part. In other chronic pain 

conditions, the pain can’t be traced to 

any specific disease or injury. The exact 

cause of the pain is unknown. In these 

cases, the chronic pain is the disease.
352 The Healthy Woman: A Complete Guide for All Ages

Whatever its cause, chronic pain can interfere with all aspects of your life. It can:

l	 make it difficult to work and interact 

with family and friends

l	 make you feel irritable and depressed

l	 make it hard to sleep

l	 make you lose interest in food and sex

l	 make you less inclined to get physical activity (as a result, you may gain 

weight, which can make some chronic 

pain problems worse)

l	 lead to dependency on narcotic painkillers or alcohol as a way of coping 

with chronic pain

l	 cause you to have the burden of many 

doctor bills that come from trying to 

treat it

Chronic pain is different from acute 

pain, which is pain that lasts less than 3 

months. Acute pain, such as pain from a 

cut, is closely linked to an injury, infection, or inflammation. Inflammation is 

the body’s response to injury or irritation, 

signaled by pain, swelling, redness, and 

heat. When the cause of the acute pain 

goes away, so does the pain.

Getting diagnosed

The first step in treating your pain is a 

diagnosis. During your first visit, your 

doctor will ask you questions about:

l	 when your pain started

l	 location of your pain

l	 how your pain feels (for instance, does 

it feel like a sharp stabbing pain, a 

steady burning, or a dull ache?)

l	 what makes your pain better or worse

l	 how the pain affects your activities 

of daily living (for instance, bathing, 

dressing, and eating)

l	 all of the medicines that you have 

ever used to treat your pain (both 

those that were prescribed by a doctor 

and those that you bought over the 

counter)

l	 any side effects you may have from 

these medicines

The doctor may also ask you questions to 

find out if you are depressed. Being depressed is quite common among patients 

with chronic pain. For some patients, 

though, the depression comes first. The 

chronic pain may be caused by or be part 

Your doctor maY show You a Pain intensitY scale, such as this numeric rating scale, and ask You to rate 

Your Pain on a scale from 0 to 10.
Pain 353

of the depression. In fact, many people 

who are depressed complain about pain 

problems, such as frequent headaches, back 

pain, or stomach pain, rather than depression. The only way your doctor can find 

out and treat your real problem is for you 

to answer your doctor’s questions honestly.

Managing your pain

Treatments for pain include: 

l	 medicines

l	 physical therapies

l	 psychological and behavioral therapies

l	 complementary and alternative 

therapies

l	 surgery

To get a treatment plan involving a variety of approaches, you may want to try a 

pain clinic. These clinics have a team of 

therapists, including:

l	 doctors

l	 psychologists

l	 physical therapists

l	 complementary and alternative therapists (such as acupuncturists or massage therapists)

Together, the team will put together a 

pain management plan for you, often involving a combination of different treatments. If you do not have a pain clinic 

where you live, ask your doctor for referrals to therapists near you.

Because everyone is different, a treatment that works for one patient may not 

work for others. You may have to try a 

variety of treatments before you find one 

or more that work for you.

Medicines

Medicines that reduce pain are called 

analgesics (an-uhl-GEE-ziks). They 

block the pain signals carried by nerves 

but do not cure the problem that is causing the pain. When an analgesic wears 

off, the pain often returns.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs 

(NSAIDs) are a class of analgesics. They 

reduce pain and also reduce fever and inflammation. Common ones include:

l	 aspirin

l	 ibuprofen

l	 naproxen

When used once in a while, these drugs 

cause few side effects. But long-term use 

can irritate the stomach and intestines. 

NSAIDs other than aspirin also may 

increase the risk of heart attacks and 

stroke. Some of the NSAIDs may cause 

liver or kidney disease as well.

Acetaminophen

Acetaminophen (uh-see-tuh-MIN-uhfuhn) works in much the same way as 

NSAIDs but doesn’t reduce inflammation.

Acetaminophen is less likely to bother 

the stomach than NSAIDs. But taking 

too high a dose of acetaminophen can 

damage your liver, especially if you drink 

a lot of alcohol.

Opioids

Opioids (OH-pee-oids), or narcotics, are 

the most powerful pain medicines. Opioids commonly prescribed include morphine, methadone (METH-uh-dohn), 

and oxycodone (OKS-ih-KOH-duhn).
354 The Healthy Woman: A Complete Guide for All Ages

Opioid side effects include:

l	 nausea 

l	 vomiting

l	 feeling drowsy

l	 difficulty having a bowel movement

If you take an opioid drug for more than 

a week or two (and, for some people, 

as little as a few days), you can become 

physically dependent on the drug. This 

means that you will have withdrawal 

symptoms when you stop taking the 

drug. Withdrawal symptoms include 

nervousness, diarrhea, and tremor, or 

shaking. Physical dependence on opioids 

is a normal response to taking the drugs 

and not something to be overly concerned about. Physical dependence is not 

the same as addiction.

Addiction to opioids means that you 

crave opioid drugs and feel driven to take 

them for reasons other than easing your 

pain. You spend a lot of time finding and 

taking the drugs and neglect your family, job, and other responsibilities. You 

may buy the drugs illegally and get into 

trouble with the law.

When taken properly, the chances of 

becoming addicted to opioids are low. 

But many doctors and patients are overly 

concerned about the risk of opioid addiction. As a result, patients are sometimes not given high enough doses of 

opioids and suffer pain needlessly.

Early research suggests that women’s 

pain responds better than men’s to a class 

of opioids called kappa opioids. This 

suggests that male and female brains 

handle pain signals in different ways. It 

also suggests that kappa opioids might 

Serious Side Effects of 

Methadone

Women are more likely than men to 

have serious side effects with methadone use. Call 911 or go to the nearest emergency room if you are taking 

methadone and get one or more of 

these symptoms:

• rapid, irregular pulse 

• sensation of feeling the heart beat

• light-headedness or dizziness 

• fainting 

• shortness of breath 

• chest discomfort or pain

be an option for women in pain who do 

not respond well to typical opioids. More 

research is needed in this area.

Researchers are also working on developing opioid medicines that hopefully 

will not be addictive and will have fewer 

side effects. Some of these are showing 

promise in research on animals. But none 

are yet available for use in humans.

Antidepressants and anticonvulsants

Some medicines used to treat depression 

can treat some painful conditions, including migraine and tension headaches. In 

a way, this is not surprising, because we 

know that the part of the brain where pain 

is processed is also involved in depression.

Other medicines that can been used 

for treating certain types of pain are 

anticonvulsants. These medicines were 

developed to treat epilepsy. But they are 

sometimes useful for treating painful 

conditions caused by damage to the nervous system.
Pain 355

Other therapies for pain

Your therapists may suggest nondrug 

treatments instead of or along with 

taking medicines. Not only do women 

use more nondrug therapies than men, 

women are more likely to respond well 

to them.

Physical therapy

Many patients with chronic pain move 

as little as possible, thinking that physical activity will harm them. In fact, the 

opposite is true. When you get out of 

shape, your pain may become worse. If 

you have a chronic pain problem, a physical therapist can help you find a physical 

activity program that is gentle, moderate, 

and right for you. You should follow the 

program, even if you feel some pain during physical activity. In this case, the pain 

does not mean that you are harming your 

body.

Types of physical therapy that may help 

your pain include:

l	 heat treatment—hot water baths, 

heating pads, high-frequency sound 

waves to produce gentle heat deep in 

your tissues

l	 cold treatment—ice packs, ice baths, 

ice massage

l	 gentle stretching

l	 muscle-strengthening physical 

activities

l	 massage—applying pressure to specific 

points on the body

l	 vibration therapy—a probe is applied 

to a part of your body with moderate 

pressure and vibrated several thousand 

times per second

Nerve stimulation therapies

These therapies involve the use of low 

electrical currents and/or fine needles 

that are placed in specific parts of the 

body. Acupuncture is one example. These 

therapies seem to interfere with the 

sending of pain signals to the brain. They 

may also cause the body to release natural painkillers, called endorphins.
356 The Healthy Woman: A Complete Guide for All Ages

Psychological and behavioral therapies

Therapies that help you relax or change 

your thinking patterns can sometimes 

help you cope with pain. Examples of 

these therapies include:

l	 cognitive therapy—helps you to gain 

control over your pain by teaching you 

to recognize and change emotions that 

can make pain worse, such as anxiety, 

anger, and sadness

l	 progressive muscle relaxation— 

tensing and then relaxing muscles 

helps to ease muscle tension that may 

be adding to your pain

l	 deep breathing exercises—helps you 

to relax

l	 guided imagery—imagining a pleasant 

scene takes your mind off your pain

l	 biofeedback—electronic equipment 

tells you about your muscle tension, 

skin temperature, and other body 

functions, so you can learn to control 

these functions and reduce your pain

Pain can make depression worse, and 

depression can make your pain worse. So 

if you are in pain and also are depressed, 

you need to treat depression and pain at 

the same time.

Chronic pain disorders

Many chronic pain disorders common 

among women have no known cause. To 

diagnose your pain, your doctor will need 

to rule out other possible causes. This 

might take a long time. Once your pain is 

diagnosed, you can explore your treatment 

options with your doctor. Symptoms of 

some common disorders and their treatments can be found in this table.

Tension headache

Symptoms • tight band of pain around head

• tense muscles in back and neck

• often occur at times of high stress

• often go along with depression

Treatment • relaxation—taking a break from what you’re doing and resting in bed

• Biofeedback

• analgesics (usually nsaids)

• antidepressants 

• stress management
Pain 357

Migraine headache

Symptoms • throbbing pain that usually starts on one side of your head and then spreads

• light, sound, and physical activity can make pain worse

• nausea and vomiting

•	 Aura	(jagged,	shimmering,	or	flashing	lights	or	a	blind	spot	with	flickering	edges)	about	1	

hour before the migraine begins

• tingling, balance problems, weakness in an arm or leg, problems talking

• sometimes goes along with depression

Treatment • 

• 

•

• 

• 

avoiding migraine triggers

medicines called triptans are good at stopping a migraine from progressing if taken when 

it is just beginning. (in very rare cases, triptans have caused heart attacks and death in 

healthy young women.)

other over-the-counter and prescription medicines to provide pain relief or prevent migraines

medicines to help nausea and vomiting

Biofeedback; relaxation training

Tracking Your Migraines

A sudden, severe headache could be a sign of a stroke. For more information, see the 

Stroke chapter on page 37.
358 The Healthy Woman: A Complete Guide for All Ages

Temporomandibular (TEM-puh-roh-man-DIB-yuh-lur) joint disorders (TMJ)

Symptoms • Pain in the chewing muscles or temporomandibular joint(s), which connects your lower 

jaw to the bones on the side of your head

• clicking, popping, or grating sounds in the joint when you open or close your mouth

• limited movement or locking of the jaw

• Pain in the face or neck

Treatment • eating soft foods

• massaging painful muscles

• moist heat or cold packs on the face

• relaxation techniques

• nsaids or muscle relaxants

• reducing stress

Complex regional pain syndrome

Symptoms • Burning pain that often starts after an injury to a muscle, nerve, or other tissue

• Pain worsens over time even though injury has healed

• Pain spreads, often affecting an entire arm, leg, hand, or foot

• affected area might also have:

 • changes in skin temperature and color

 • changes in nail and hair growth patterns

 • sweating

 • swelling

Treatment treatment is aimed at relieving symptoms. therapies include:

• Physical therapy

• Psychotherapy

• medicines, including antidepressants, opioids, and analgesics applied to the skin

• injecting a drug that blocks the nerves thought to play a role in causing the pain

Chronic fatigue syndrome

Symptoms • long-lasting fatigue that doesn’t get better with rest

• flu-like symptoms, headache, sore throat, muscle and joint aches, and fever

Treatment • nsaids for the fever, headache, and body pain

• antidepressants to improve sleep and mood

• moderate physical activity

• cognitive therapy to help you keep a positive outlook
Pain 359

Fibromyal

Symptoms

gia (feye-broh-meye-AL-juh)

main symptoms:

• Pain felt all over the body

•	 Tenderness	or	pain	in	at	least	11	of	18	“tender	points,”	specific	spots	on	the	neck,	shoulders, back, hips, arms, and legs

other symptoms:

• fatigue

• trouble sleeping

• morning stiffness

Fibromyalgia Tender Points

Treatment • 

• 

• 

• 

• 

Pregabalin (pre-gaB-uh-lin) and other anticonvulsant medicines 

sleeping longer and better by changing bedtime and sleep habits or using medicines to 

help you sleep

low-impact physical activity, such as walking or swimming

reducing stress

massage

If you have pain in your chest, this could be a sign of angina (an-JEYE-nuh) or a 

heart attack. For more information, see the Heart Disease chapter on page 15.
360 The Healthy Woman: A Complete Guide for All Ages

Osteoarthritis (OSS-tee-oh-ar-THREYE-tuhss)

Symptoms • Pain and swelling in joints

• limited joint motion

• might be able to hear the sound of grinding bones

Treatment • nsaids to reduce pain and swelling

• opioids

• moderate physical activity, such as swimming

• heat and cold treatments

• surgery to repair or replace damaged joints

• weight control

Carpal tunnel syndrome

Symptoms symptoms begin gradually, starting with:

•	 Numb	or	tingling	sensation	in	first	3	fingers	

over time, you might feel:

•	 Burning,	aching	feeling	in	these	fingers

• Painful numbness in your palm

•	 Shooting	pain	from	your	wrist	into	the	forearm	or	fingers

•	 Trouble	moving	your	fingers

Treatment • wearing a splint to keep your wrist from bending

• nsaids to reduce pain and swelling

• surgery

Injury-related pain

If you have experienced a serious injury, 

such as a bone fracture or severe bleeding, consult a doctor as soon as possible. Also, consult a doctor if you have 

received a blow to your head that causes 

you to have one or more of the following:

l	 blurred vision

l	 slurred speech

l	 loss of memory

l	 loss of consciousness

If you have a minor injury, such as a 

sprained ankle, you can often treat the 

problem yourself with the classic RICE 

treatment:

l	 R (rest). Reduce or stop using the 

injured area for at least 48 hours. This 

will minimize bleeding and swelling.

l	 I (ice). Put an ice pack on the injured 

area for 10 minutes and then remove 
Pain 361

it for 10 minutes. Keep this up for at 

least an hour and then repeat for as 

long as swelling and bruising continue.

l	 C (compression). Gently compress, 

or squeeze, the injured area with an 

elastic bandage. Don’t wrap the area so 

tightly that you cut off blood flow.

l	 E (elevate). Keep the injured area 

raised above the level of the heart to 

help decrease swelling. Use a pillow to 

prop up an injured arm or leg.

If RICE treatment does not help your 

injury, be sure to see a doctor.

Why do women have more pain 

disorders?

Scientists don’t know why women get 

more chronic pain disorders than men. 

But they have some theories:

Women may be more sensitive to pain.

In one research study, scientists looked 

at the pain responses of newborn babies. 

When nurses pricked their heels to get 

blood for a lab test, girl babies showed 

more pain on their faces than boy babies. 

This suggests that females may be more 

sensitive to pain than males right from 

birth.

In research studies with adults that look 

at normal pain responses, women usually 

report more pain than men. Women also 

have more sensitive pain reflexes. For 

instance, women pull their leg up sooner 

than men when increasingly greater electric shocks are applied to a nerve in the 

foot.

Research has shown that women become 

more sensitive to pain after repeated exposure to painful stimuli than do men. 

Some think that a lifetime of painful 

experiences, such as painful periods, may 

make a woman’s nervous system more 

sensitive to pain. As a result, sensations 

that normally would not be felt as painful are in some women. This might explain disorders such as fibromyalgia, in 

which pain is felt all over the body.

Female sex hormones may help cause pain 

disorders.

Pain disorders seem to be related to sex 

hormone levels in many women. For 

instance, after puberty, when sex hormone levels rise, girls start to have more 

migraines than boys. But other painful 

conditions, such as joint pain, don’t become more common in women until after menopause, when sex hormone levels 

drop. It’s not clear yet which hormones 

affect pain and, if they do, how they 

affect pain.
362 The Healthy Woman: A Complete Guide for All Ages

If you’re in pain

No matter why women have more painful disorders than men, the fact is that 

they do. If you’re in pain and you’re not 

getting the help you need from your 

doctor, feel free to switch doctors. If your 

health plan doesn’t allow you to switch 

doctors or you live in an area where there 

aren’t any other doctors, then you need 

to speak up for yourself to get the treatment you need.

No woman should be told that her pain 

isn’t real or not severe enough for treatment. You deserve to live your life as 

pain-free as possible. n

O
Pain 363

O

I

n 1996, i accepted a position as the transportation planning manager for the city of 

alexandria, Virginia. living and working in the washington, dc, area was a dream i had 

held dear for many years.

most of my life i had suffered with migraine headaches, often going to the 

emergency room for treatment. my 

headaches became worse, and i found The doctors I 

myself struggling to keep up the pace. 

the doctors i consulted gave me a variety of reasons for my pain, from aller- consulted gave me 

gies to the pollution to a lung infection. 

after a year, i realized i had to make a a variety of reasons 

change to improve my health, and i left 

my dream job for a rural area without 

pollution. for my pain...

the next few years i struggled not only 

with fatigue, but widespread pain, stiffness, and noticeable cognitive issues. 

I	finally	had	to	move	back	to	my	home	in	Shreveport,	Louisiana.	After	spending	three	

months	in	bed,	I	was	diagnosed	with	fibromyalgia	in	January	2001.	I	was	barely	able	to	

get up for meal preparation and necessary household duties. obviously, i was no longer 

able to work. 

it took years of navigating the insurance issues and multiple therapies before i found 

a	doctor	whose	eyes	did	not	glaze	over	when	I	mentioned	fibromyalgia.	He	believed	the	

symptoms	of	fibromyalgia	were	real,	and	he	even	conducted	research	to	help	his	patients.

Since	2004	I	have	been	taking	a	medicine	that	has	lessened	my	pain	levels	and	diminished the fatigue to a point that i have a quality lifestyle. i also now understand what is 

happening	to	my	body	to	cause	the	many	symptoms	caused	by	fibromyalgia.

Berenda 

Shreveport, Louisiana
364 The Healthy Woman: A Complete Guide for All Ages

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/faq/

carpal.htm 

www.womenshealth.gov/faq/migraine.htm 

Phone number: (800) 994-9662,

(888) 220-5446 TDD

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases, 

Information Clearinghouse, NIH

1 AMS Circle

Bethesda, MD 20892-3675

Web site: www.niams.nih.gov

Phone number: (877) 226-4267,

(301) 565–2966 TTY

National Institute of Neurological 

Disorders and Stroke, NIH

PO Box 5801

Bethesda, MD 20824

Web site: www.ninds.nih.gov

Phone number: (800) 352-9424,

(301) 468-5981 TTY

NIH Pain Consortium

Bethesda, MD 20892

Web site: http://painconsortium.nih.gov/

pain_index.html 

American Chronic Pain Association

PO Box 850

Rocklin, CA 95677

Web site: www.theacpa.org

Phone number: (800) 533-3231

American Pain Foundation

201 North Charles St, Suite 710

Baltimore, MD 21201-4111

Web site: www.painfoundation.org 

Phone number: (888) 615-7246

The Chronic Fatigue and Immune 

Dysfunction Syndrome Association of 

America

PO Box 220398

Charlotte, NC 28222-0398

Web site: www.cfids.org

Fibromyalgia Network

PO Box 31750

Tucson, AZ 85751-1750

Web site: www.fmnetnews.com

Phone number: (800) 853-2929

National Headache Foundation

820 N Orleans, Suite 217

Chicago, IL 60610

Web site: www.headaches.org

Phone number: (888) 643-5552

National Pain Foundation

300 E Hampden Ave, Suite 100

Englewood, CO 80113

Web site: www.nationalpainfoundation.org