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Chronic pain conditions in women - fibromyalgia related research

  [ 146 votes ]   [ Discuss This Article ] • April 9, 1999

There are inconsistent data on the age/sex prevalence pattern of
back pain and on chest pain. However, it is possible that for
chest pain, the rates are higher in younger women and older
men. Neck pain, joint pain, and fibromyalgia all appear to
increase with age in both genders, whereas abdominal pain and
tension-type headaches decrease with age, and migraine
headache and TMD appear to peak in the reproductive years. A
concluding example illustrates how epidemiologic data can be
used to enhance our understanding of the causes of pain. A
higher prevalence in women and a peak prevalence during the
reproductive years as seen in TMD suggest that either biologic
or psychosocial factors unique to women in this period of life
could increase the risk of developing or maintaining this
pain. As female reproductive hormones can play a role in
migraine, at least for some women, it would be interesting to
examine whether hormones play a role in TMD.

The situation
that occurs when menopause is followed by hormone replacement
therapy (HRT) provides a natural experiment similar to a
laboratory experiment in which female animals are deprived of
the natural sources of hormones and then hormones are replaced
exogenously. In women, of course, the decision to receive HRT
may be associated with a number of psychosocial variables that
might also influence pain. Recognizing these limitations, data
from records of a large health maintenance organization were
examined to ascertain whether use of estrogen or progestin (or
both) in postmenopausal women might be associated with the
occurrence of TMD pain and, thus, whether the hormone
hypothesis might be worthy of further investigation.

women with TMD than controls used estrogen replacement
therapy, and slightly more patients than controls used
progestin. The use of estrogen significantly increased the
odds of having TMD. Progestin use showed a weaker association,
which did not hold up after other factors were controlled.
However, the risk of TMD appears to increase with increasing
doses of estrogen. A review of the epidemiologic literature
indicates that there are definite age and sex differences in
the prevalence of many chronic pain conditions. There is
little basic information about the source of these
differences, such as different onset rates, different
probabilities of recurrence, or different durations of pain,
or combinations of these in women and men. Nevertheless, a
systematic examination of the existing epidemiologic data may
be an important step in helping pain researchers to generate
hypotheses in the search for a better understanding of chronic
pain in both sexes.

Meisler JG

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