Pain: Pathophysiology, Age and Gender Factors

Introduction

People often seek medical assistance with one common symptom – pain. However, the classification of this phenomenon shows how challenging it may be for a medical professional to diagnose pain accurately. Pain can be classified as acute, referred, or chronic according to its pathophysiology. It is vital for clinicians to know how to distinguish one type of pain from another because the diagnosis may affect treatment and patients’ outcomes (Hammer & McPhee, 2014). Moreover, patients’ individual characteristics such as age or gender can also impact the way pain is felt, perceived, and treated by people. Older individuals and children may respond to pain more strongly than adults, while women and men may have difficulties in describing and evaluating their pain because of stigma.

Pathophysiology of Pain

Three main types of pain can be described with different pathophysiology and presentation. Acute pain is an immediate response of the body to harmful experiences (Huether & McCance, 2017). It can be considered a call to action that the neurological system sends to the individual for him/her to eliminate the source of harm. Acute pain is temporal and can last from seconds to several months, depending on its cause. Its pathophysiology shows that the onset is rapid and sudden. Peripheral pain receptors become activated under the influence of stimuli, transmitting electrical signals through nociceptors to the brain, spinal cord, or thalamus (Huether & McCance, 2017). Both A-delta and D fibers can carry these signals.

Referred pain is a type of acute or chronic pain that is felt in an area removed from its source. The spinal segment supplies the electrical signals to both sites – the actual and the perceived one (Huether & McCance, 2017). As the signals are similar to each other, the brain cannot distinguish between them, and the person feels pain in the most sensitive part of the body, the skin.

Finally, chronic pain is a separate type because of its persistent nature. A person with constant pain experiences discomfort for more than three months. In this case, the nervous system does not respond to noxious stimuli adequately. Chronic pain is disproportionate to any possible injuries of one’s body, revealing an altered behavior of the nervous system and its mishandling of nociception processes (Huether & McCance, 2017). It may be localized or referred, as well as ongoing or intermittent, but the physiology of chronic pain is similar to that of acute one. However, its persistent nature leads to many psychological changes in people, including depression and sleep or eating disorders.

Patient Factors: Age and Gender

Age and gender are factors that can impact the diagnosis and treatment of pain. Children and older adults are more receptive to pain because their sensitivity is high while the pain threshold is low (Huether & McCance, 2017). Thus, it may be easy for them to identify pain through pathophysiological responses – vomiting, nausea, or elevated heartbeat. These groups of people may also need a more delicate treatment than adults due to the heightened sensitivity of the nervous system.

Stigmas related to gender may limit people’s abilities to receive the correct diagnosis and treatment. As Stålnacke et al. (2015) find, women are often underdiagnosed with pain-related conditions due to the belief that females inflate their symptoms’ description. As a contrast, male patients may hide their discomfort and pain thinking that they need to appear both physically and mentally stronger than others (Berke, Reidy, Miller, & Zeichner, 2017). Thus, professionals should have open conversations with both men and women, paying attention to their behavior and non-verbal signals to assess pain.

Conclusion

Acute and chronic types of pain differ in longevity, although they have similar pathophysiology. They can be localized, activating at the site of the problem, and referred, appearing in areas remote from the affected region. Children and older people may have a lowered pain threshold which results in a more evident and severe manifestation of pain. Men and women can suffer from stigmatic perceptions of pain based on their gender.

References

Berke, D. S., Reidy, D. E., Miller, J. D., & Zeichner, A. (2017). Take it like a man: Gender-threatened men’s experience of gender role discrepancy, emotion activation, and pain tolerance. Psychology of Men & Masculinity, 18(1), 62-68.

Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th ed.) New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Stålnacke, B. M., Haukenes, I., Lehti, A., Wiklund, A. F., Wiklund, M., & Hammarström, A. (2015). Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment? Journal of Rehabilitation Medicine, 47(4), 365-371.