Abstract
Women have a higher prevalence than men of several clinical pain conditions and of
inflammation-mediated disorders. There is also increasing evidence for sex differences
in sensitivity to experimental pain and in the response to analgesics. Estrogen, progesterone,
and other gonadal hormones have a complex role in inflammatory processes and the pain
response. Microglia cells in the central nervous system, which have sex hormone receptors,
become activated in response to inflammatory stimuli, releasing cytokines and other
mediators that are pronociceptive and can amplify the pain response. Although the
mechanisms underlying sex differences in pain and analgesia have not been fully elucidated,
both peripheral and central nervous systems pathways may be involved. Sex differences
in the opioid, dopaminergic, serotoninergic, and other pain-related systems have been
documented; and some evidence suggests that differences are most pronounced during
the peak reproductive years. Psychosocial factors also play an important role. Given
the important role of inflammation in mediating pain, nutritional factors that modulate
the inflammatory response offer a promising and exciting new avenue for the prevention
and treatment of chronic pain disorders. Of particular interest is the potential role
of moderate- to high-dose vitamin D and omega-3 fatty acid supplements, both of which
have powerful anti-inflammatory effects. These nutritional interventions, which influence
cytokine, leukotriene, and prostaglandin pathways, may be of particular benefit to
women due to their higher prevalence of inflammatory chronic pain disorders. The recent
launch of a new large-scale randomized trial of these nutritional supplements provides
an opportunity to assess their potential antinociceptive role. Additional research
is needed to clarify the mechanisms for sex differences in pain and to develop new
treatment modalities that improve pain management for both men and women.
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Article info
Footnotes
Publication of this article was supported by the Collège International de Recherche Servier (CIRS).
STATEMENT OF CONFLICT OF INTEREST: The author has nothing to disclose.
VITAL is being conducted by our research group at Brigham and Women's Hospital, Harvard Medical School (Principal Investigator: JoAnn E. Manson, MD). The VITAL ancillary study on autoimmune disease and joint pain is being conducted by Dr Karen Costenbader, MD (Principal Investigator), and colleagues at Brigham and Women's Hospital, Harvard Medical School.
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© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
