WOMEN'S PAIN IS DIFFERENT FROM MEN'S—THE DRUGS COULD BE TOO
MEN AND WOMEN can’t feel each other’s pain. Literally. We have different biological pathways for chronic pain, which means pain-relieving drugs that work for one sex might fail in the other half of the population.
So why don’t we have pain medicines designed just for men or women? The reason is simple: Because no one has looked for them. Drug development begins with studies on rats and mice, and until three years ago, almost all that research used only male animals. As a result, women in particular may be left with unnecessary pain—but men might be too.
Now a study in the journal Brain reveals differences in the sensory nerves that enter the spinal cords of men and women with neuropathic pain, which is persistent shooting or burning pain. The first such study in humans, it provides the most compelling evidence yet that we need different drugs for men and women. There’s a huge amount of suffering that’s happening that we could solve," says Ted Price, professor of neuroscience at the University of Texas, Dallas, and an author of the Brainarticle. “As a field, it would be awesome to start having some success stories.”
Modern-day pain control is notoriously dismal. Our go-to medicines—opioids and anti-inflammatories—are just new versions of opium and willow bark, substances we’ve used for thousands of years. Although they are remarkably effective in relieving the sudden pain of a broken bone or pulled tooth, they don’t work as well for people with persistent pain that lasts three months or longer. The failure to include sex differences in the search for better pain relief stems in part from flawed but deep-seated beliefs. “[Medical researchers] made the assumption that men and women were absolutely identical in every respect, except their reproductive biology,” says Marianne Legato, a cardiologist who began sounding an alarm in the 1980s about differences in heart attack symptoms among women. She went on to pioneer a new field of gender-specific medicine.
The physiology of pain is just one of many ways that men and women differ, she says. But she isn’t surprised that no sex-specific medicines have emerged. The medical community—including pharmaceutical companies—didn’t appreciate the variation between men and women, including in their metabolisms, immune systems, and gene expression. "If there were differences in how their drugs worked between men and women, they didn’t want to hear about it," she says. New studies must have separate cohorts for pain studies, rather than aggregating it into one data set.
What is the legacy of gender-blind research? Mogil once emailed a researcher, asking whether a pain drug worked better in men than women. The researcher didn’t know, and couldn’t pursue the question because the data was controlled by the pharmaceutical company. Mogil was left wondering if drugs that looked promising in male-only animal studies might have failed in clinical trials when the results were blended with those in women, depriving men of a viable treatment.
Medicines that could work best for women wouldn’t make it into the pipeline at all when basic science excluded female animals. Price wonders if unresolved pain among women might have led to their higher levels of chronic pain.
Amid the promise of "personalized" medicine, with drugs tailored to patients based on genetic sequencing, developing pain medicines for half the population seems like a no-brainer. "Now there’s a whole new frontier opening up in front of our eyes," Price says.
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