Does menopause effect development and treatment of chronic pain?

Introduction: There is mounting evidence that females and males differ in how they experience pain and respond to spinal cord stimulation(SCS). Whether the responses females have changes after menopause has not been defined. To determine how these measurements affect outcomes with SCS, it is first necessary to define normal ranges in chronic pain patients. Further, to ensure that all genders, races, and ethnicities receive therapy for chronic pain, it is necessary to obtain a representative sample from across the U.S. We used the NIH-sponsored All of Us database to determine the relationship of menopause with pain intensity across groups.

Methods: We identified participants in the database with a diagnosis of chronic pain and who had numeric rating scale(NRS) data available. Severe pain was defined as NRS ≥7. Among those with chronic pain, cohorts were divided into females ≥51 years who were presumed to be menopausal, females 18-50 years who were considered pre-menopausal, and age matched male cohorts. Menopausal status was required to be present in the female cohort to be included.

Results: The 53,289 participants were separated into four cohorts by age and sex: females 18-50(10,269), females ≥51(20,182), males 18-50(4,989), and males ≥51(17,849). NRS scores between the four cohorts differed significantly(H = 99.71, p < 0.001). Post Hoc Dunn’s tests indicated significantly higher pain intensity scores in females 18-50 compared to females > 51 and compared to males > 51(p < 0.001). The scores of females > 51 were significantly lower compared to males 18-50 and significantly higher compared to males > 51(p < 0.001). Scores of males 18-50 were significantly higher than those of males > 51(p < 0.001). In white, black, and non-Hispanic patients, older males and females had lower mean NRS scores as a group compared to younger participants(p < 0.001).

Conclusion : These data suggest that menopause impacts the intensity of pain in women. When assessing age, demographic variables need to be considered. These factors should be considered when assessing outcomes with SCS or any pain therapy.