But the pain that suddenly overtook her in 2004 beat anything she’d ever known before. “It was like my whole body had tendinitis,” she says. “It hurt to take a shower, to have the water touching my skin.” When she got home at the end of the day, she curled up on the sofa, trying not to move. Halstead was baffled about what was wrong with her, and so was everyone else. She went from doctor to doctor, but none of them could find a cause. “I got so frustrated with physicians telling me I was exaggerating or it was all in my head,” she says. “I’m in the military. I know what pain is.” In 2005, when Halstead was 46, her doctors finally identified the reason for her continuing agony: fibromyalgia, an excruciating soft-tissue condition that affects seven times as many women as men. She was handed a fistful of prescriptions but then deployed to Iraq. She tried the drugs for a couple of years, without much relief. Thousands of service members depended on Halstead’s unwavering concentration, but the pain was taking too much out of her. Back stateside, sitting at her kitchen table one night in 2008, she made the wrenching decision to leave the career she had loved for 27 years. She submitted her retirement and, for the first time in many years, wept. The kind of pain caused by Halstead’s fibromyalgia—unrelenting, hard-to-treat, long-term agony—is called chronic pain, and it has taken an enormous toll on people’s lives, productivity, and happiness, especially women’s. But that’s starting to change. As scientists have been working for the past 20 years to understand more about chronic pain, doctors have been finding new ways to vanquish it. And at last, women are starting to see the results. MORE: Tried-And-True Cures For Fibromyalgia A New Understanding of Pain Humans can’t survive without pain: It alerts us to danger and injury. Touch a hot iron and chemicals released by the affected cells in your finger trigger an electrical signal that races up the nerves of your arm to your spinal cord. From there, the signal is transferred to some of the relatively primitive areas of your brain involved in sensory perception (your thalamus and midbrain), which transmit the sensation to the neocortex and the limbic system, which assign a type and intensity to the pain. Since these areas are also involved in memory and emotion, the pain also receives a psychological overlay and links to other memories there. Only then does the pain register, and that’s when you realize that your finger has been burned. This is called acute pain: It serves a clear purpose and usually goes away when its job is done. But because of the different levels of processing in your brain, your experience of it is subjective and individual: If someone drops a hammer on your big toe, it may feel much more (or much less) painful to you than it would to your spouse if the same hammer landed on his or her big toe. During the past couple of decades, however, researchers have come to understand more about another kind of pain. Chronic pain affects a staggering 100 million Americans and is arguably the most expensive public health problem in the country, costing as much as $635 billion annually. Women are significantly more likely than men to suffer from chronic pain, with rates of chronic neck, shoulder, knee, back, and headache pain 1½ times higher than men’s. Chronic pain may start out as acute pain, such as a sprained ankle or a C-section, or as pain from an ongoing condition, such as arthritis. “The important thing to understand is that chronic pain is not simply prolonged acute pain,” says Allan Basbaum, PhD, the chair of the anatomy department at the University of California, San Francisco. Pain signals that are repeated over and over can eventually cause physiochemical changes that make nerve pathways ultrasensitive. Once this happens, your brain interprets pain impulses traveling on them as more intense and harder to regulate and suppress. If you don’t interrupt the process through treatment, those changes can become embedded in your central nervous system so that your brain keeps sending you pain messages about an injury that may no longer exist. That doesn’t mean the pain is imaginary: It’s very real. But it does mean that it’s harder for doctors to diagnose or treat, which, combined with the subjective nature of both kinds of pain, can lead to patients facing disbelief when they seek help. “A lot of doctors have thought that women were just exaggerating,” says Josephine Briggs, MD, director of the National Center for Complementary and Alternative Medicine. “A lot of pain has just been dismissed.” (Make sure you’re not making any of these mistakes that make pain worse.) While we still don’t know what purpose, if any, chronic pain serves, researchers have made significant inroads into another of chronic pain’s mysteries: why women seem to be more susceptible than men. “When you walk into any pain clinic, you see mostly women,” says Roger Fillingim, PhD, a professor at the University of Florida who studies factors that influence the experience of pain. The disparity is partly because many conditions that can lead to ongoing pain—fibromyalgia, migraines, endometriosis, and many more—occur less often or not at all in men. But doctors began to suspect there was more to it than that. Now they’re finding that women may actually be more sensitive to pain than men. “For years, people believed that women were typically less susceptible to pain because we go through childbirth,” says Dr. Briggs. “But that common wisdom is just plain wrong.” Because of pain’s subjective, individual nature, it’s not something you can measure as easily as, say, cholesterol or blood sugar, but scientists have developed methods such as the hand-in-ice-water test. In one study, researchers offered volunteers $1 for every 15 seconds they could keep a hand submerged in a bucket of ice water. Men tolerated the cold for more than a minute longer than women did. And although the size of the difference varies from study to study, other research is remarkably consistent in finding that there is a difference between men’s and women’s perceptions of pain, says Dr. Fillingim: “Women simply have a more effective pain-detection system than men do, meaning that they tend to feel pain with greater depth and intensity.” And now that we have improved brain-imaging technologies, recent research has backed up these findings, says Catherine Bushnell, PhD, who is leading studies of pain perception at the NIH. Using high-field MRIs, researchers have found that the brains of women in pain differ from men’s in both how they look and how they respond. Take migraine: One study found brain structures that help control consciousness, emotion, and pain processing are thicker in female migraine patients than in male ones, suggesting that these areas are built differently. If you’re not a medical researcher, all this may not strike you as very happy news, but think about the implications. Just as researchers a few decades ago realized that cardiovascular disease takes a different course in women than in men (It’s true; here’s the proof), many scientists now are making a case for differences in how women and men feel pain. The hope is that better understanding will lead to better treatment for chronic pain. Toward a Pain-Free Future Given the tools that are now available and the evolution of our understanding of chronic pain, I believe we are poised for important discoveries," says Dr. Fillingim. In fact, the research is already starting to change lives. Take Sara Welch, 47, a copywriter in Jersey City, NJ, who suffers from a tugging pain in her hip. “It started 20 years ago. It didn’t stop me from walking, but I avoided climbing stairs and bending down,” she says. “It wasn’t excruciating, but it was always there, and I was always working around it.” She consulted a sports medicine doctor, who recommended some stretching exercises, which helped a little but not much. Over the next several years, she went to a slew of doctors, got x-rays and MRIs that didn’t find anything, and tried physical therapy and chiropractic to no avail. Eventually, not knowing what else to do, she visited an acupuncturist. After eight weekly sessions, the pain receded, and Welch left it at that, putting up with the remaining twinges. But the pain returned in full force when she started a new job last year. This time around, Welch went to a pain-management center at NYU Langone’s Center for Musculoskeletal Care. “They specialize in lower-back pain and have a whole team that works very closely together, so the doctor [an osteopath] knows what the physical therapist is doing and so on,” she says. The osteopath put her on mild painkillers and muscle relaxants, but Welch is now off the latter and working to get off the former. He also reviewed (and approved) the supplements she takes. Best of all, the team put her on a physical therapy regimen that’s really working. “Last time I did physical therapy, I had different people every time, but now I work with one therapist to build my core and the muscles that support my hip joint,” Welch says. In addition to her weekly sessions, she does stretches at home twice a day, plus strengthening exercises every other day. “I am so much better now,” she says. “I go for days and days without any hip pain at all, which is amazing.” (See how else you can reduce pain with fitness.) Not everyone has as heartening a story as Welch’s—many people continue to face chronic pain that’s difficult to control. But the new discoveries about pain are leading to more and more successes, and first and foremost among the changes may be that more doctors understand that chronic pain patients are truly suffering. “I’ve had patients cry from relief when I assured them that what they feel is real,” says Heidi Seifert, MD, a pain specialist in Houston. “There’s dignity in having a diagnosis.” Like Welch, anesthesiologist Michael Sabia, MD, division head of pain management and pain medicine fellowship director at Cooper University, also sees the team approach to pain management as a major improvement. “Years ago, you’d go to a GP who’d try to treat your pain with prescriptions,” he says. “Now we have a multidisciplinary team: a physician, a nurse-practitioner, a physical therapist, maybe a physiatrist to evaluate the physical causes, a surgeon if surgical intervention would help, an anesthesiologist to handle pain-medicine injections, a psychiatrist to work with other kinds of medications—all trained in pain management.” The team approach allows care to be closely tailored to each patient’s problems and needs. There’s no standard approach, because pain isn’t one-size-fits-all. “You have to figure out the best way to treat each patient by working with her and providing whatever will help,” Dr. Sabia says. And, of course, doctors have much more in their pain-fighting arsenal of tools and technology than they did 20 years ago. Take cryoneurolysis, which involves identifying the problematic nerve and inserting a needle to freeze it for 3 minutes, says William Moore, MD, a thoracic interventional radiologist at Stony Brook University School of Medicine. “Patients who have been living with high levels of pain—8 or 9 on a scale of 1 to 10—typically report that their pain subsides to around 2 for 6 to 9 months or more after treatment,” he says. After the level rises to 4, the procedure can be repeated. It takes less time—and may hurt less—than dental work. That’s just one technique. There’s also radiofrequency ablation, in which the nerves are burned rather than frozen. It’s been around since the 1970s, says Dr. Sabia, who performs 12 to 15 of the procedures weekly, but only in the past few years has imaging technology become sophisticated enough to allow doctors to pinpoint the exact nerve to be treated. “Treatment is changing all the time,” he says. “We have oral medications now that are better targeted to reach and work on nerve pathways that have been in pain for 3 to 5 years.” And he’s excited about what the future holds. “There’s abundant research about minimally invasive treatments,” he says, “and there are scads of innovations awaiting FDA approval.” One day in the future, he believes, epidurals might be used to implant stem cells that could actually regenerate injured or diseased nerves. This Is Your Brain on Pain Some research suggests more activity in women’s cingulate cortex, which deals with emotional regulation and response, learning, and motivation, than in men’s. Men in pain showed greater response than women in the insular cortex, which is linked to consciousness, sensory processing, and motor control. Further off, too, is the possibility of gender-specific drugs that allow for differences in experiences of pain. Today, almost all early-stage studies of drugs are conducted using male rodents. “That means when you’ve spent 20 years and millions of dollars developing a new painkiller, you’re going to come up with a drug that works better in men than in women,” says Jeffrey Mogil, PhD, the E.P. Taylor Chair of Pain Studies at McGill University. Women are supposed to be part of later-stage clinical trials, but those rules came into play in the 1990s—so we’re still in the dark about how well a lot of drugs actually work for women. However, new evidence reveals that some opiates may work differently in the two sexes: Morphine, for example, tends to be more effective in women. And Dr. Mogil thinks that one day in the future we may see analgesics that take gender difference into account. MORE: 7 Celebrities Living With Chronic Pain What You Can Do Right NowSweat the small stuff. If you have acute pain—say, aching after a knee injury—that doesn’t improve in 3 weeks, check in with a pain specialist, advises Dr. Sabia. “Run-of-the-mill aches and pains generally last between 5 and 10 days,” he says. “If yours persists longer, or if it radiates from one part of your body to another, there’s a chance that a major nerve could be involved.” Shutting down pain circuitry before it becomes ingrained may help you avoid long-range, difficult-to-treat pain. See a specialist. Better yet, see a team of pain-management specialists. Dr. Sabia recommends looking for a team that includes at least one member who’s been certified after completing a postgraduate fellowship in pain management. “They’re up-to-date on the most cutting-edge research and techniques,” he says. Don’t dismiss drugs. People in pain may feel stigmatized because they take pain medication, says Tracy Rydzy, LSW, 34. A former social worker who left her job because of ongoing back pain, she now writes a blog for others with chronic pain (ohwhatapain.wordpress.com). “You can feel judged, like people think you’re just not trying hard enough,” she says. There shouldn’t be any shame attached to medication, but you should understand the pros and cons of what you take. The most commonly prescribed medicines for chronic pain are opiates, like Vicodin and Oxycontin, says Jennifer Reinhold, PharmD, a Prevention advisor. “They work by actually blocking the pain signals before they reach your brain,” she explains. However, they can be addictive and cause side effects such as respiratory problems, drowsiness, and constipation, so you may want to work with your doctor to find the minimum dose that’s effective for you. Investigative alternatives. “Start by picking things that you know make you feel good, whatever they are,” says Karen Berkley, PhD, professor emeritus of neuroscience at Florida State University. Simple lifestyle changes often have a surprising impact. For example, getting regular, gentle exercise, like joint-friendly tai chi, can help ease pain caused by rheumatoid arthritis. (Sound interesting? Here’s how to get started.) Other evidence-based options include getting a dog, going to a massage therapist, meditating, and changing your diet—all of these may reduce pain incrementally. Mix and match. “Looking for a single solution to get rid of your chronic pain is a near-impossible goal,” says Dr. Berkley. “Instead, search for the right combination of answers.” After retiring from the army, Becky Halstead decided to manage her pain without drugs—and through regular exercise, careful nutritional choices, and chiropractic care, she succeeds. “I may not be entirely free of my pain,” she says, “but it doesn’t define me anymore.” Today she’s a motivational speaker and helps others take ownership of whatever life throws at them—and take back their happiness, too. For more pain solutions, consider these additional 14 Pain-Fighting Strategies. MORE: 30-Second Foot Pain Fix
