We have previously discussed opioid prescribing for chronic pain and highlighted the challenges of ensuring that optimal treatment for chronic pain is generally accessible. Prevention of chronic pain may offer an important strategy that has not been well explored
Addressing social determinants of health may be one way in which to prevent the development of chronic pain and thus reduce the impact that pain has upon the population of Canada.
We know that being female, or being part of a marginalized population, are factors known to confer elevated risk of experiencing chronic pain, but the underlying mechanisms are not well established.
Food and shelter instability are contributors to poor health by limiting dietary adequacy, and being female presents specific health risks associated, among other things, with iron deficiency.
Iron deficiency – overlooked in the context of chronic pain
Iron plays a role in pain perception- it is critical to the synthesis of serotonin, a neurotransmitter known for its powerful pain-modulating effects. Symptoms of iron deficiency are similar to those of chronic pain conditions, such as fibromyalgia.
Recently, the World Health Organization reported that as many as 30% of women are iron deficient. Laboratory standards for ‘normal’ values for women’s iron storage testing in the past were inappropriately low, reflecting a lack of recognition of the importance of ongoing loss of iron through menstruation.
In the province of Ontario, Canada, normal values of ferritin [a measure of iron stores] have recently been updated to reflect recognition of this problem and promote more active attention to iron replacement, especially for women.
Treatment of concurrent iron deficiency among people living with chronic pain may also help reduce symptoms. Iron is essential for hemoglobin production, which carries oxygen throughout the body, and iron deficiency anemia may result in muscle and joint pain due to tissue damage and inflammation.
Drawing from some fascinating work by UK researcher Dr Toby Richards [The Iron Clinic] identifying and treating iron deficiency in athletes, we are undertaking a survey of women attending the DeGroote Pain Clinic to identify the proportions at risk for iron deficiency. Results will be available soon, and may direct interventions to come.
