pain | MY SPECIAL DOCTOR

Women perceive pain more than men

23 February 20246 January 2024 by clemente.ferrara

Perception of pain in women and men

The differences between men and women have always been the subject of scientific study. Male human beings differ greatly from female human beings, both anatomically speaking and emotionally and psychologically. According to some scholars, men and women would also have a different approach to physical pain, with female individuals having a greater sensitivity than male subjects. In fact, according to some data, the percentages referring to men’s and women’s perception of pain are very different. In women it ranges from 45.6% to 56% while in men it ranges from 32% to 44%. These differences become even more significant under the age of 18 or in individuals over 65, where the percentage for women is 40.1 percent versus 23.7 percent for men.

Backing up these data is gender medicine, in the words of Marina Rizzo, a neurologist at the United Hospitals of Palermo, according to whom, “There are many differences between genders and many factors that condition the different perception between males and females, particularly for severe pain.” According to the doctor, among the main factors that would influence pain perception would be sex hormones: “From clinical studies it seems that testosterone has a protective action on pain. The association between decreased androgen concentration and chronic pain has been seen while estrogen hormone use increases pain perception. Variations in pain symptoms during the menstrual cycle are then known.”

Pain receptors

Corroborating Dr. Rizzo’s thesis are the words of Dr. Diego Fornasari, a pharmacologist at the University of Milan, who highlights the differences at the biological level between men and women in the mechanisms involved in the regulation and transmission of pain at the level of synapses, or connections that allow the transmission of impulses from peripheral nerve fibers to those carrying the impulse to the central nervous system. Dr. Fornasari explains, “This synapse is absolutely critical because this is where the history of a painful stimulus can be greatly altered, for example, in processes of pain chronification. We have descending pathways that modulate the activity of this synapse that act like semaphores that pass impulses. Out of one thousand impulses two hundred may pass or one thousand may pass or, in chronicization, the one thousand impulses may be perceived as ten thousand.” This control mechanism, according to the expert, is influenced by the area of the brain involved in emotional life, called the limbic cortex, and it is precisely the different approach to emotionality between men and women that also consequently differentiates their perception of pain. For Fornasari in fact, “There are definite neuronal connections between the areas of our emotional life and pain. Here’s that if I have a complex, disturbed emotional life these descending pathways might work less well.”

For gout sufferers, sleeping well is often a dream

22 February 20246 January 2024 by rosanna.feroldi

Better explaining to the physician the impact of rheumatic disease symptoms on night rest is important to optimize therapy and improve quality of life.

Gout is a rheumatic disease characterized by the deposition of uric acid crystals within the joints, leading to the development ofchronic inflammatory arthritis associated with extremely painful recurrent acute attacks. Available therapies, combined with some dietary and lifestyle measures, can reduce the frequency of attacks and lessen the symptoms of the disease when they occur, but not eliminate them completely.

Sufferers, therefore, often have to deal with pain, burning, and swelling, usually very intense and associated with the substantial inability to move and use the affected joints (especially, wrists/hands, elbows, knees, or ankles/feet), either during the day or at night, for periods that can exceed 1-2 weeks.

A recent study conducted at the University of Alabama (United States) verified that in addition to the discomfort caused by the disease in daily life, the majority of patients with gout also experience serious sleep impairment nocturnal, with all that comes with it in terms of residual fatigue, nervousness, and decreased physical and intellectual performance during the day. To make matters worse, then, sleep deprivation at night increases pain sensitivity, further worsening the discomfort. In short: a dog biting its own tail that can come to much harm if the unfavorable interference between pain and sleep is not prevented or, at least, defused early.

The first step to do this is to optimize basic drug therapy and the anti-inflammatory and antalgic therapy that is essential in gout flare-ups, but alone it is not enough. Indeed, the same study warns that it is not only physical pain and the inability to assume a comfortable position in bed that prevent patients from sleeping soundly.

Also interfering with falling asleep and causing frequent awakenings are anxiety and depression consequent to concern about the symptoms of the acute attack and about suffering from a chronic “fickle” and unpredictable disease, the need to get up frequently to go to the bathroom to urinate, the side effects of medications prescribed to control the rheumatic disease, and, in a proportion of patients, the interference of gout with the ability to effectively manage obstructive apnea syndrome.

According to the researchers, compensating for all these aspects requires a “broadened” approach that takes into account the full range of disorders experienced by the patient and provides targeted remedies that can alleviate them. To this end, it is imperative that physicians actively investigate all possible critical issues associated with acute gout attacks and individual reactions to prescribed medications, but if they do not do so, it must be the patients who accurately report all the physical and mental symptoms they experience, throughout the day and night, and their variations over time. With a little effort on both sides and adherence to prescribed therapies, the situation will surely improve.

Source

Singh JA et al. Any sleep is a dream far away: a nominal group study assessing how gout affects sleep. Rheumatology 2018;57(11):1925-1932. doi:10.1093/rheumatology/kex535

Menstrual symptoms reduce productivity in women of childbearing age

15 February 20246 January 2024 by rosanna.feroldi

If you think that the physical and psychological discomforts that can accompany the days of menstrual flow and those leading up to it are a minor thing, you are either a man or a very lucky woman. Even when one does not suffer from actual conditions associated with the menstrual cycle such as endometriosis, in fact, the symptoms that most women have to deal with periodically throughout all or part of their fertile lives are quite challenging to endure and manage. Cramps and pain in the lower abdomen, which may radiate to the legs; back pain; nausea and intestinal discomfort; difficulty concentrating and headache; fatigue and general malaise; irritability, nervousness; depression or anxiety. Although benign and transient, combined in various ways in type and intensity, these manifestations can significantly interfere with daily activities for one or more days, preventing one from fulfilling one’s study and work commitments to the best of one’s ability. With socioeconomic repercussions as well, given the loss of productivity. A nationwide Dutch study involving nearly 33 thousand women, recruited from the general female population of childbearing age (15-45 years), assessed this impact through the administration of online questionnaires that investigated both the loss of productivity associated with menstrual flow-related absences from school or the workplace and that associated with “presenteeism,” i.e., being present in less than excellent mental and physical condition. The responses obtained showed that 13.8 percent of women of childbearing age occasionally have to take time off work or study commitments due to menstrual disorders, losing an average of 1.3 days per year. While this figure may appear reassuring (but it is not, considering that this is an average value and that menstrual flow is a physiological phenomenon and not a disease), the same cannot be said of the percentage of related presenteeism and reduced productivity, experienced by as many as 80.7 percent of the study participants for an average of 23.2 days per year (i.e., about 2 days per cycle). The researchers calculated that a loss of productivity of one-third (33 percent) of that secured under optimal psychophysical conditions for the average recorded period of presenteeism corresponds to a total annual loss of productivity of nearly 9 days: on a par with real illness. In addition, it should be considered that the absenteeism found among the women involved in the survey is likely to be lower than the actual absenteeism, since those responding to the online questionnaire were predominantly women with higher levels of education and engaged in activities that require less physical exertion than those performed by women with lower levels of education. The study also confirms that despite the considerable discomfort caused by menstrual flow, only a minority of women turn to the doctor for a satisfactory solution (45 percent according to the Dutch research, but around 15 percent in other surveys), resigning themselves to living with periodic discomfort. This is a situation that should be sought to be changed through increased education of both women and physicians in the protection of women’s well-being and reproductive health, and by developing labor policies geared toward providing greater flexibility of hours and tasks, with a view to reducing inconvenience and loss of productivity during the most critical phase of the cycle. For the benefit of all.

Source: Schoep ME et al. Productivity loss due to menstruation-related symptoms: a nationwide crosssectional survey among 32748 women. BMJ Open 2019;9:e026186. doi:10.1136/bmjopen-2018-026186

Photo by Katarzyna Grabowska on Unsplash

Neck and back injuries

15 February 20246 January 2024 by Redazione My Special Doctor

In the case of a traffic accident, from falls or from diving, all victims should be treated as if they had a spinal cord injury. As a result, victims may also report head injury, numbness, weakness or burning sensation in the limbs, paralysis of the arms, deformity, and pain in movement. It is necessary to examine spinal function by swiping the sole of the foot toward the big toe with a wrench or other sharp object. If the big toe bends downward the reaction is normal, but if the big toe bends upward it is a spinal or brain injury. At this point ask the conscious victim a series of questions:

“Do you feel pain?” Neck injuries radiate pain to the arms, upper back injuries radiate pain along the ribs, lower back injuries radiate the pain along the legs.
“Can you move your feet?” The rescuer must ask the victim to move your foot against his hand. If he fails in this movement, he will It is probably a spinal cord injury.
“Can you move your fingers?” If the victim is able to move his or her fingers, the pathways nerves are intact.

If the victim is unconscious try to provoke Of reactions by shaking hands and feet. The absence of reaction could indicate spinal cord injury.

What to do?

Check the ABCHs and call the ambulance.
Leave the victim in the position he or she is in.
Immobilize the victim to prevent him or her from moving.

If the victim is lying down, grasp the victim’s clavicle and trapezius muscle and lift the head between the inner side of your forearms. Keep the head and neck immobile until the ambulance arrives.

Source: Mediserve‘s Pocket Guide to First Aid.

15 relevant symptoms that should not be ignored

8 February 20246 January 2024 by Redazione My Special Doctor

It is not always easy to draw the difference between minor and intense pain. These situations require medical advice.

Disorders of the body – Pain in pediatric age

4 February 20246 January 2024 by Redazione My Special Doctor

Pain, unfortunately, can affect even the youngest children. In this case, the first elements to consider are the measurement of pain, which uses appropriate rating scales, and the estimation of its impact on the child’s well-being, in terms of reduced liveliness and avoidance of activities he or she finds most pleasurable.