Sometimes it's hard to be a man

Men should take better care of themselves. We die at an earlier age than women, despite women suffering more health conditions and making greater use of health services. Life expectancy differences may be different because of biology, but we also know that men engage in riskier activities, including poorer lifestyle choices. Men are more likely to drink excessively and smoke, both of which are associated with serious health conditions and increased hospital admissions.

Most worryingly, men are more likely to commit suicide, where they are three times more likely to take this route – percentages as high as 75% in the UK and 79% in the US have been recorded.

Campaigns such as Men’s Health Week and the seasonal sprouting of facial hair in support of Movember aim to get men more involved in their health. Men are less likely to talk about their health concerns because masculinity is commonly associated with being stoic rather than emotional. But to improve our health it’s time to start talking, and acknowledging pain is a good place to start.

Common pains

Pain is a signal that demands our attention – it tells us to take note and take care. It is common, yet complex in nature, and up to 19% of Europeans are reported to be in chronic pain.

Pain is associated with high levels of disability – the latest figures from the Global Burden of Disease Study group show that lower back pain is associated with the highest years lived with disability. Other types of pain also appear in the top 20, including neck pain (fourth), migraine (sixth), osteoarthritis (13th).

Neck pain: fourth leading cause of years living with disability.Neck by Shutterstock

Pain also shows gender-related differences – women report more pain compared to men, are more likely to use analgesics and visit a pain specialist. However, this doesn’t mean men are immune from pain and related disability.

Data from the Health Survey for England in 2011 found 37% of women and 31% of men reported chronic pain, and figures from a recent US study found 21.6% of women and 16.2% of men reported persistent pain (which is frequent pain that lasts for more than three months). Both studies illustrate that men are not far behind in terms of the levels of pain they experience.

Painful silence

Despite the general focus on men’s health through events such as Movember, this has not yet translated to what we specifically know about men’s pain. There are clearly conditions that affect men, where pain may play a role, for example prostatitis, a prostate-related condition that can include pain. Embarrassment around such symptoms may prevent men seeking help.

There are also differences in pain behaviour, in that women report using a wider range of coping techniques, including social support. It is less clear what men do. Reporting pain and suffering is likely to be a problem for some, especially if they believe they should be strong, and not show signs of vulnerability.

Lab studies have shown that gender-based beliefs affect pain reporting, with pain tolerance levels higher in those with a strong masculine identity. But is this effect due to reduced pain sensitivity, or an unwillingness to show pain? Pain can also affect male gender identity, especially if men feel unable to meet expectations about what it is to be male. Pain can affect sexual function, which in turn can affect gender identity and contribute to depression.

Gender differences

While research into men’s pain exists, it is still somewhat limited. We should build on the general interest in men’s health, and see if we can develop it in the context of pain. We still need to discover what the key mechanisms are for explaining why men and women differ in pain.

There is a general reluctance in research to look for sex and gender differences. We are trying to change this through our own studies - we are currently inviting men and women to tell us more about their pain.

There will be important similarities, but differences too, and it is here we need to find out what is specifically relevant to men and women’s pain. It would seem sensible to know whether gender differences in pain are due to a reluctance in men to seek help.

We also need to know whether there are some approaches that are better suited to help men to deal with their pain. For example, can those interested in pain management learn from the men’s health literature, and develop initiatives to help men find better ways to talk about pain? A “men’s sheds” approach, which provides a physical space for men to meet and learn new skills, can be used to reduce isolation and improve health awareness – could be one approach to take.

Ultimately, we need to look beyond the idea that pain is a sign of weakness, and ask how men can use pain to stay fit, healthy, and alive for longer. Frank and open discussions about other notions of masculinity will also drive healthier behaviour in men.

Edmund Keogh receives funding from Reckitt Benckiser Healthcare (UK) Limited, and Engineering and Physical Sciences Research Council.