Chronic Understanding Pain – Gillian Best

They’re not always good models of human behaviour, particularly in relation to the female life course.’ But if our inflammation is influenced by our sex hormones, could that be why so many people I spoke to for this book noticed their pain started around the same time as they got their first periods? I noticed my first set of strange, random attacks around the same time that I got my first period – but the pain didn’t really ‘take’ until later on.

Professor Watt says, ‘I think this question about what makes females different starts early in life, and when you look at some chronic musculoskeletal pain, the time you start to see an excess in females, it seems to be around the teenage years.’ And it seems to be at menarche (the start of menstruation) and afterwards that we start to see increased rates of fibromyalgia in girls, increased rates of pelvic pain in girls. There are other painful conditions that can be seen in the younger population, so it does seem that, as women develop that sex hormone axis, there is a higher tendency to pain.

‘Whether that links into being more likely to develop a condition like ankylosing spondylitis feels quite different to me,’ Professor Watt says. ‘Because that’s asking a different question, isn’t it? Which is, What’s happening to my immune state now, is that to do with sex hormone modulation? We really don’t know.’ I ask, again, if people with autoimmune disease could maybe just have low baseline levels of sex hormones to start with. Professor Watt says, ‘People are less likely to be prescribed HRT with these rheumatic conditions.

I think there is an inequity there. Because there’s a general conservativeness which may be quite right to say, “Gosh, we’re worried about X or Y, so we can’t let you have HRT.” But actually if you look at the population in the rheumatology clinics there, I’m quite sure there will be lower proportions now of women taking these things as opposed to if you look at people bounding around without these conditions, who’ve gone to their GP and are now on oestrogen.’ She readily admits she doesn’t have the evidence to say any of this beyond her experience, which would be that there’s lots of hesitancy for HRT if you’re being seen for other conditions, particularly in a hospital or specialist setting, because hospital physicians are more conservative than GPs, and GPs would look to specialists to advise in this scenario.

Published in the UK and USA in 2026 by Icon Books Ltd, Omnibus Business Centre, 39–41 North Road, London N7 9DP email: [email protected] www.iconbooks.com ISBN: 978-183773-272-2 ebook: 978-183773-274-6 Text copyright © 2026 Gillian Best The author has asserted her moral rights. No part of this book may be reproduced in any form, or by any means, without prior permission in writing from the publisher. Typesetting by SJmagic DESIGN SERVICES, India Printed and bound in the UK Appointed GPSR EU Representative: Easy Access System Europe Oü, 16879218 Address: Mustamäe tee 50, 10621, Tallinn, Estonia Contact Details: [email protected], +358 40 500 3575 1kitap1.com/en For Kerri 1kitap1.com/en CONTENTS Prologue 1 Pain, the basics 2 Can CAR T-cell therapy treat my disease(s)?

3 Your brain is in pain 4 Sex differences in pain 5 What’s the central nervous system got to do with it? 6 The beginning, genetically speaking 7 Did I get this from my parents? 8 How your perception of your body alters your pain experience 9 Predicting pain 10 Chronic pain on a population-wide level 11 How to improve chronic pain research 12 What if pain isn’t driven by the brain?

13 Stopping inflammation and repairing it too The end Acknowledgements 1kitap1.com/en PROLOGUE I’m writing this from the hospital. It’s cold and brightly lit. My nurse today, a lovely woman named Jolly, is frowning at the cannula because I won’t bleed for her. It’s nothing personal, I’m just not a great bleeder. I can feel her try to shimmy the needle into my vein a bit more; something about seeing her do that makes it hurt, or maybe that’s just what I think, so I look away.

What I do know is that we need to get three vials of blood and so far we’ve got maybe half of one. Jolly gets the bright blue elastic band and together we tie it on my arm, just above the elbow. We leave it there for a moment and then untie it, both of us watching and hoping the vial will fill. No such luck. She massages the vein, which doesn’t work, so we move my arm off the arm rest and see if gravity might help.

It doesn’t. I apologise profusely for the stubbornness of my blood. We decide to cut our losses and try after my infusion is done.

This is a short excerpt from the opening of “” by Unknown, quoted for review and introduction purposes. All rights belong to the copyright holders.

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