Chronic Pain and Gender: Biological Mechanisms and Clinical Implications for Personalized Pain Medicine

Abstract

The 2020 definition by the International Association for the Study of Pain (IASP) characterizes pain as “an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage.” This definition emphasizes the individualized nature of pain, influenced by biological, psychological, and social factors. Recent research has focused on understanding the subjectivity of pain and the biological diversity among individuals, particularly examining gender differences in pain perception and management, and exploring the underlying pathophysiological, emotional, and social mechanisms. Epidemiological and clinical data consistently show that women are more prone to develop chronic pain conditions over their lifespan, presenting higher prevalence rates across various painful disorders. Conditions such as osteoarthritis, rheumatoid arthritis, migraine, fibromyalgia, and interstitial cystitis exhibit well-documented female predominance. For instance, a 2019 Spanish study involving 22,842 patients found significantly higher rates of pain among women—25.68% vs. 12.54% for chronic neck pain, 27.03% vs. 18.83% for chronic low back pain, and 15.93% vs. 6.74% for migraine or frequent headaches. Women with pain also more frequently used medications for pain, anxiety, depression, and sleep disturbances. Despite these observations, the mechanisms underlying gender disparities in pain perception and chronicity remain only partially understood. Current evidence suggests a complex interplay between genetic, hormonal, inflammatory, and immune factors that may contribute to both the development and persistence of chronic pain in women. Continued research is essential to unravel these mechanisms and tailor gender-specific approaches for effective pain management and treatment strategies.