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Chronic pain conditions in women – fibromyalgia related research

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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.

More

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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