A Physician’s Perspective on Treating Women with Pain and Addiction: Challenges and Opportunities
To complement our recent spotlight on the research of Dr. Jenny Wilkerson and Dr. Anna Konova, we asked Dr. Alopi Patel, MD, Associate Professor of Anesthesiology and Perioperative Medicine at Rutgers Robert Wood Johnson Medical School, to share what she sees in her clinical practice with female patients.
Alopi Patel, MD
Dr. Patel is a double board-certified anesthesiologist and interventional pain specialist who is also certified in lifestyle medicine. She co-hosts The Hurt Podcast by The Female Pain Docs. Dr. Patel brings a patient‑centered lens to understanding women’s pain and addiction‑related challenges.
Dr. Patel noted that chronic pain affects women disproportionately and that several conditions appear more commonly in her female patients. One of the common conditions she manages is pelvic pain, which can stem from endometriosis, fibroids/adenomyosis, interstitial cystitis/painful bladder syndrome, pelvic floor dysfunction, vulvodynia, nerve entrapments, and dysmenorrhea. Beyond the pelvis, she frequently sees fibromyalgia, migraines, temporomandibular joint disorders, and pain associated with autoimmune conditions such as rheumatoid arthritis and lupus. While chronic low back pain, neuropathic pain, and complex regional pain syndrome occur across both genders, she observes that in women the pain rarely appears in isolation — it often overlaps with mood disorders, prior trauma, or hormonal transitions such as pregnancy and perimenopause. She frequently sees how these conditions are minimized or attributed to stress or mental health before a thorough evaluation is undertaken.
Given the discoveries in Dr. Konova’s lab that we highlighted in our recent feature, we asked Dr. Patel whether clinicians currently time therapeutic interventions to the menstrual cycle for treating pain and addiction in women. Dr. Patel explained that awareness is growing, but the practice remains informal and uncommon. She noted that pain sensitivity, inflammatory activity, and even medication metabolism can shift across the menstrual cycle. In practice, however, cycle-aware treatment timing tends to be limited to menstrual cycle-related migraine or dysmenorrhea rather than applied as a deliberate strategy in managing pain. However, she sees that there is an opportunity to formalize this approach: using cycle phase to optimize the timing of interventions, anticipating symptom flares, and individualizing dosing. In addiction medicine in particular, emerging evidence on hormonal influences over craving and relapse vulnerability suggests that cycle-informed approaches warrant attention.
When asked what she would ideally like to have in her treatment and diagnostic toolkit, Dr. Patel emphasized the need for tools that reflect the biological realities of female patients rather than treating them as a variant of a male default with minimal monthly hormonal variations. She would value reliable diagnostic markers capable of distinguishing inflammatory from neuropathic and centralized pain, which would help shorten the prolonged diagnostic process so many women experience. Sex-specific pharmacokinetic and dosing data would also be invaluable, since most analgesics and addiction therapies were developed based on studies predominantly conducted in men or male animals. She would also welcome more non-hormonal therapeutic options for conditions such as endometriosis, better-validated screening instruments for pain that presents atypically in women, and integrated approaches that account for the frequent co-occurrence of pain, mood disorders, and trauma. Finally, Dr. Patel mentioned the need for decision-making resources that help clinicians recognize cyclical patterns and adjust treatment accordingly.
According to Dr. Patel, addressing these gaps requires both better tools and a shift in clinical culture where we take women’s pain conditions seriously.
Click here to schedule an appointment with Dr. Patel
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