Are men and women the same when it comes to pain?

In these more modern times of sexual equality, it may not be politically correct to talk about differences between men and women. Unfortunately, the medical profession cannot ignore the increasing volume of scientific evidence that there are important differences, particularly when it comes to pain management. In this, it is important to distinguish between biological sex and gender. There are visual tests for the presence or absence of reproductive organs, and lab tests for chromosomes that help to say whether this is a man or woman. Gender, on the other hand, is a list of the social roles society defines for people. This can be complicated when people choose to act or behave in ways considered more appropriate for the opposite sex. As an example of the problem, you only have to look at the complaints that Caster Semenya is not a woman. How can this muscular person from South Africa suddenly beat the word record for the 800m by one second and be a woman?

The last decade has seen a rapid rise in the volume of research into gender differences in the response to pain. There is clear evidence that women are more likely to consult a doctor about pain and to take drugs to relieve that pain. As a result, the national statistics show more women than men suffering from the more common medical conditions causing pain such as arthritis, irritable bowel syndrome, fibromyalgia, etc. In tests involving healthy volunteers, women are more likely to report higher levels of pain than men. This applies regardless of the other factors of age, race, ethnicity and religion. Interestingly, brain scans have shown that pain affects different parts of the brain. In women, the limbic area which also affects emotions is stimulated more than in men.

The speculation is that the differences in brain activity flow from early human development. Men were the stronger group with responsibility to fight to defend the community. This means being prepared to accept pain. Women were expected to respond to danger by nurturing and protecting the young, running away if necessary. Today, men remain less willing to admit to feeling pain and are reluctant to seek medical help. It does not matter whether this is a biological or gender difference, the statistical evidence for this unwillingness to seek help is absolutely clear. But, equally clear is that tramadol relieves the pain of both a macho man and an emotional woman. Even though there may be gender differences, the biological effect of tramadol is the same on a human body. It relieves moderate to severe pain. So, perhaps it is time for all men suffering in silence to overcome the cultural conditioning that threatens their self-esteem if they admit to pain. Once you have clearance from your local healthcare provider that there are no problems in you taking this drug, go online and buy tramadol from the privacy of your own home. This relieves the pain and preserves your image.

The FDA changes the warning notices

Many people think the Food and Drug Administration's role is limited to licensing new drugs and medical devices, but it actually has a post-marketing role as well. Doctors and hospitals all round the US are required to report any and all adverse side effects to drugs. It's not uncommon to find that drugs can pass through clinical trials involving only thousands of participants, but show side effects when millions start taking them. Obviously, many problems come from those who abuse the drugs in one way or another but, every now and again, serious problems emerge over time. Once a pattern emerges, the FDA can either change the labels on the drugs to give stronger warning to patients or, in the worst cases, withdraw the licenses for the drug to be used. Since withdrawal can have a dramatic effect on the manufacturer, the FDA prefers to improve the level of warnings unless the problems are too severe to ignore.

Doctors have been aware of the problems of serotonin syndrome for some years. It's a potentially serious adverse side effect when people ingest too much serotonin. Perhaps it's better to think of this as a form of poisoning caused when people take excessive dosages of one drug or mix different drugs together. The effects fall into four main classes:

• a change to metal status - you may become agitated, hallucinate or, in extreme cases, fall into a coma;
• the body may start to function erratically and your blood pressure rises, your heart races and your body suddenly loses or retains heat;
• loss of physical co-ordination; and/or
• nausea, vomiting and diarrhea.

In some cases, the result has been death, e.g. the high-profile case of Libby Zion in 1984 which produced a change in the law of New York limiting the working hours for medical postgraduates and requiring their close supervision by senior physicians at all times. Thus, the FDA is not reacting to a new problem, but merely increasing the visibility of the warning notices as it affects all drugs containing serotonin.

In this instance, the warnings affect tramadol in the following ways. It always has been the case that an overdose of any of the opioid painkillers can cause this syndrome. Fortunately, this particular problem is relatively uncommon. Even those in the most severe pain understand the risks of exceeding the safe dosages are too dangerous to justify. Accidental overdose is almost unknown. So the most common problem arises with interactions between tramadol and other drugs with a serotonin content. The most dangerous combinations come with the classes of antidepressants called serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, and triptans.

The syndrome can arise even though you take the safe prescribed dose of the painkiller. So the warning is not so much about the painkillers themselves, but to alert people not to self-medicate. Since the rise of the online pharmacy industry, too many people have been buying drugs without a prescription - that means without talking through the risks with a doctor. Obviously, a doctor with access to a person's medical history would immediately identify the dangers and either change the dosages or change the drugs. When people rely on recommendations from friends or the information they glean from the internet to decide what drugs to take, they can be putting themselves at risk. Hopefully, this new warning will prevent problems and keep people safe.