Women's pain syndromes are complicated and probably involve multiple factors, both genetic and environmental, but several aspects are critical to the development and treatment of female pain syndromes.
Much anecdotal evidence suggests that pain disorders are often preceded by specific events or conditions. For example, fibromyalgia is sometimes preceded by a viral infection and precipitated and exacerbated by fatigue, lack of sleep and possibly nutritional factors. Similarly, migraines are often associated with hormonal changes occurring at the onset of puberty and during the normal reproductive cycle. Pelvic pain has also been tied to use of birth control at an early age and to menopause. With a better understanding of what triggers pain syndromes, we will be armed to develop strategies to prevent and treat these disorders.
Why some pain disorders occur predominantly in women is unclear. However, a role of female reproductive hormones has been long suspected.
There is mounting evidence that these pain syndromes are rooted deeply in the biology of the nervous system. Some types of pain are associated with increased amounts of certain proteins that can affect the excitability of pain-sensing pathways. Estrogen can affect the proteins that alter nervous system properties and can affect sensitivity of the nerves themselves. Some tissues that are affected in female pain syndromes have been shown to have greater than normal numbers of nerves.
Because there may be no overtly obvious damage or deformity, female pain disorders are typically very difficult to diagnose. Indeed, this may contribute to the under-diagnosing of these very common pain syndromes. A major part of the problem is a lack of good markers for pain disorders.
Our ability to address some symptoms associated with female pain syndromes has advanced rapidly in recent years. In addition to behavioral management techniques that improve quality of life, this includes development and marketing of new drugs such as triptans for migraines and anti-seizure medications for pelvic pain and fibromyalgia. However, treatments to date are essentially all aimed at the symptoms rather than the causes.