Redheads and Pain Tolerance

Redheads Require More Anesthesia in Surgery

For many years, anesthesiologists have anecdotally observed that redheads required more anesthesia in surgery. In 2004, Dr. Edwin Liem from the University of Louisville, Kentucky, decided to put this theory to the test. He conducted controlled scientific experiments and confirmed that female redheads require 19 percent more anesthesia in surgery. In a follow up study in 2005, he confirmed that female redheads “were significantly more sensitive to cold pain perception, cold pain tolerance, and heat pain tolerance”, and that again they were resistant to injected anesthesia, but not as resistant to topical anesthesia. They restricted the studies to women to eliminate the possible differences in analgesic pathways between men and women. This effect may not be the case for all female redheads so it is important that you discuss these findings with your doctor if you ever have the need for a surgical procedure.

But why? How? In the central nervous system, different hormones work together to create balance in perception of pain: alpha-MSH increases sensitivity to pain via melanocortin receptors, MC3R and MC4R, while opiates decrease sensitivity to pain. Dr. Liem postulates that there is a negative feedback loop from the malfunctioning MC1 receptor in redheads to the pituitary, which induces it to secrete excess circulatory alpha-MSH. The excess alpha-MSH acts on other fully functioning receptors in the central nervous system, MC3R and MC4R, and overpowers the opiate hormones. The result is a hormone imbalance and increased sensitivity to pain. Read more about this negative feedback loop in The Red Hair Factory. Redheads may also be susceptible to altered serotonin secretions from the skin melanocyte cells, which may exacerbate this effect since serotonin is a known modulator of pain. In a personal communication, Dr. Liem mentioned that he has not been able to challenge his hypothesis regarding alpha-MSH secretions in redheads since testing this hormone is expensive and difficult due to circadian rhythms.

Wait, redheads have a higher pain tolerance? Alright, which is it?

It is important to note that the media can often misinterpret information. For instance, in August 2005 there was a media release stating that studies demonstrate that redheads have a higher pain tolerance which would conflict with Dr. Liem’s findings above; however; this information was not put in the correct context by the media. The correct context is that redheads have a higher pain tolerance over others WHEN they are drugged up on an opioid medication called pentazocine. At an August 2005 press briefing Professor Ian Jackson of the Medical Research Council’s Human Genetics Unit in Edinburgh quoted a 2003 study conducted by Jeffrey Mogil et al. In this study, it was concluded that when female redheads were administered the opioid medication pentazocine, they demonstrated a significantly higher pain threshold. This medication was not as effective on red-haired men nor on those individuals with a higher ratio of brown-black pigment. It was postulated that the medication not only stimulates opioid receptors in the central nervous system which reduces pain, but that it may also somehow prevent the pain increasing effect of alpha-MSH (a hormone that may be excessive in redheads) by blocking it from binding with the melanocortin receptors, MC3R and MC4R. The combination of stimulating the opioid receptors and blocking the stimulation of the MC3R and MC4R dramatically increases the effect of the medication.

More simply put, if you are a hot redheaded female in desperate need of an opioid pain killer, you might get a better fix on penatazocine. Of course I'm joking, I do not advocate drug use, as the adverse affects of pentazocine are similar to that of morphine. Also, as with many other opioid medications, pentazocine is addictive.

Dental Pain

On August 6, 2009, an article appeared in the New York Times called The Pain of Being a Redhead by Tara Parker-Popeimes. It highlighted a new study which appeared in The Journal of the American Dental Association. This article brought the whole redhead and pain issue to the forefront again. Participants in the study completed surveys that measured “general and dental care–specific anxiety, fear of dental pain, and previous dental care avoidance.” The authors tested the participants’ blood samples to detect gene variants associated with natural red hair color. The conclusion was that redheads were more than twice as likely to avoid dental care as were the participants without red hair, even after the authors made adjustments for general anxiety and sex.

It's interesting that the results of this study do not distinguish between red-haired males and females as the others do. It indicates that the effect was observed in both sexes. I'd be curious to know what adjustment they made for sex. I guess I'll have to pay to download the full study then! I'll keep you posted.

What's Your Pain?

Pain can manifest in so many different ways and differently in different people. So as a redhead, are these findings true for you, and if so, how does your pain manifest itself? Somebody mentioned to me last weekend that they had a redheaded friend who stated with pride that she went through labor without an epidural. To that, I say……go girl!......are you frickin’ crazy?........And why am I not more like you?

The findings regarding sensitivity to temperature are interesting. I tend to get cold very easily, but that is fairly normal for many women. Female circulation generally runs closer to the organs, while male circulation runs closer to the surface muscles. I’m also very thin and have little insulation. When I’m at one of my friend’s parties on their deck overlooking a glorious Bay Area view, I always seem to be huddled up in a hat, sweater, and gloves, while others are baring their legs. One of those more scantily-clad lassies is often my redheaded friend Sue, who never seems to get cold at all.

As a kid, my dentist drilled into my teeth without any shots or gas at all. I distinctly remember being tortured and pushing his hand away when it hurt, but I would think that would be normal for anyone. My current dentist numbs me up just fine for crown work, but I still hate going. Again, isn’t that normal?

For me, the physical pain that I had to overcome in my life had something to do with why I waited until my thirties to lose my virginity – yes, painful intercourse. It’s not something that I’m particularly excited to advertise to the world on my blog, but after reading a couple posts on the NYT article from a few other female redheads who have had a similar problem, I feel the need to share my journey for their sake and any others who can benefit from this information. Unfortunately, this topic is as shameful to discuss as menopause was many years ago. So it's about time to bring it out in the open for the purpose of healing.

The main cause of painful intercourse is usually a tight vaginal opening. Some women also are born with their urethra closer to the vaginal opening than other women, which also contributes to the discomfort. My advice in this situation is as follows:

1. Treat Infections: Make sure that any urinary or vaginal infections are treated. Drug stores sell test strips for both now. Some great infection prevention techniques are Jarrow's Fem-dophilus supplement and boric acid vaginal suppositories like Vitanica's Yeast Arrest.

2. Hygiene: Soaps can be very drying and irritating to the vagina, urethra, and rectal areas. Wash the vaginal and urethra area with a gentle pH-balanced cleanser like Sweet Spot. A proctologist told me to clean the rectal area with nothing but a good spray of water in the shower and to clean with moistened cotton medallions after bowel movements as toilet paper can be too rough. I remember thinking, really? Hey, it worked! Irritation gone.

3. Diet: Drink lots and lots of water, eat a healthy diet of whole foods, and avoid caffeine and acidic foods, which can irritate and cause discomfort to the bladder and urethra. They always recommend cranberry juice for urinary tract infections, but I find that it can be quite irritating and make you think you have an infection when you don't! Try a D-Mannose supplement to get the benefit of cranberry without so much of the acid. Common bladder irritants are: coffee (even decaffeinated), caffeinated tea, caffeinated soda, alcoholic beverages, medication with caffeine, chocolate (that's a tough one), smoking, acidic foods, citrus juices and fruits, tomatoes and tomato-based products, artificial sweetener, highly spiced foods, milk and milk products, sugar and honey, corn syrup, and cranberry juice. And if you happen to partake in the above (because let's face it, who can refuse chocolate?) just be sure to cut it with water, water, water.....

4. Physical Therapy: Get a referral from your gynecologist to a physical therapist that specializes in vaginal exercises. Yes, they actually have physical therapy for painful intercourse now and thank God! Usually, these types of physical therapists also work with women on incontinence issues.

5. Sex Toys for Stretching and Pleasuring: Purchase Dr. Berman’s vibrator dilator which starts small and can adjust gradually to larger sizes. This vibrator also works well for physical therapy.

6. Exercise: Take a yoga class. Poses such as lunges, triangles, and warriors stretch, open up, and strengthen the hips and the pelvis. Pilates is awesome too!

7. The Best Mate: Find a mate who understands, who is gentle when you need him to be, rough when you want him to be (if this pleases you!), and who loves to give and receive oral sex for variety and more options.

8. Lube up: If needed, transfer your lube into a pump container by the bed for ease of use and spontaneity. My therapist recommended Slippery Stuff, but Collective Well-Being Good Glide is my personal favorite.

9. Topical Lidocaine: Your gynecologist can give you a topical lidocaine gel that you can use a few hours before intercourse or apply a small dose daily. Dr. Liem's experiments indicate that topical lidocaine is effective on redheads.

10. Surgery: Worse comes to worse, you might need to ask your gynecologist to surgically cut your hymen to open up the space, but I encourage you to try the physical therapy first. The cut may cause some scar tissue which is less flexible and could also cause discomfort during intercourse.

I’m very happy to report that I have achieved the elusive vaginal orgasm to my surprise and satisfaction several times. So please know that there is hope out there! My physical therapist said that fairer-skinned individuals tend to have less flexible tissue, yet again one of those anecdotal observations about redheads that I always hear. Another one is from the gynecologist who always tells me that redheads are bleeders, but more on that later. So stretch, stretch, and stretch again! If you can’t get physical therapy, please write me, and I will copy the exercises into a PDF and forward them to you. And remember if I can do it, so can you.

Just for the record, if fate decides to make me a mother one day, screw natural labor - I want the frickin’ epidural and I want to give birth in a tub of water as I hear that can ease the pain too!

The Red Hair Factory

So a mutation in the melanocortin 1 receptor gene, or MC1R, causes red hair. But how and why exactly?

Let’s break it down into a simple economic analogy by using the principle of supply and demand. In a person who can tan, the demand is the external environment, or the sun. The supply is darker skin pigment, which provides more UV protection. The skin is suddenly exposed to the stress of the sun, perhaps on a beach in Maui (sigh I wish!). So it needs to produce darker pigment to protect itself from being burned. The CEO and the COO of the pigment-producing corporation are the pituitary and hypothalamus glands in the brain. This corporation has several subsidiary pigment-producing factories called skin melanocyte cells. Together the CEO, the COO, and the factories sound an alarm by producing a hormone called the alpha melanocyte-stimulating hormone, or alpha-MSH. This alarm and message reaches all of the factory managers in the subsidiary factories and instructs them to increase production of darker pigment. The managers get on the factory intercom, or the melanocortin 1 receptor (MC1R), and relay a broadcast to their assembly lines, or melanosomes, within the factory. The factory managers instruct the assembly lines to shift production from a lighter red/yellow type of pigment (pheomelanin) to a darker brown/black type of pigment (eumelanin). This process is called tanning. The factories also produce other products, such as nitric oxide, serotonin, melanocortins, catecholamines and inflammatory cytokines. These substances indicate that these factories also play an important role in immune function and in communicating between the skin and the central nervous system.

The Broken Intercom

So the above is what is supposed to happen when skin is exposed to the sun, but why does this not happen to redheads? Why do we not tan? There are any number of places where the system can break down. Specifically, the problem for the vast majority of redheads is in the intercom or MC1R. The factory manager receives the message and relays the broadcast over the intercom, yet nothing but static comes out on the other end to the assembly line (kind of like the glitchy intercom in one of the Dharma Initiative hatches on the TV show Lost). It’s like there is a short in the MC1R electrical wiring. Completely oblivious to the orders of all of their superiors, the assembly lines just keep making red/yellow pigment which is less photo-protective, burns more easily, and is more susceptible to melanoma and non-melanoma skin cancers. Basically, we get sunburned, dammit! Scientists have discovered five unique kinds of electrical shorts in various locations throughout the MC1R wiring which causes red hair. Apparently, there are other variants in the MC1R intercom which hold the mystery of the genetics of blondes and brunettes as well. Scientists are still perplexed about dark hair, pale skin, and freckles.


Negative Feedback Loop

So when the redhead intercom doesn’t work, and the factories don’t produce the darker pigment, then what happens? Well, some people think the CEO and COO in the brain find out about it in a negative feedback loop and get kind of pissed off. I mean, wouldn’t you also be upset about such blatant insubordination? And they keep sending orders out, via alpha-MSH, to ask “What the hell is going on? Produce more darker pigment now!” So theoretically, if this is true, there would be extra alpha-MSH circulating throughout a redhead’s body, causing a slight hormonal imbalance which has unforeseen consequences in other areas. This is because alpha-MSH has multiple jobs. For example, another job it has is to send messages to increase one’s sensitivity to pain, which it sends to different types of intercoms and receptors that are still functioning quite well within a redhead’s body. Plus its still unclear whether this genetic electrical short may affect the other products that the factory produces. But more of this anon in future blogs!

Other Factors in the Pigment Production System

Other issues that can come up in the production of pigment are as follows:

Raw Materials:

Phenylalanine
Darker pigment is made from phenylalanine, an essential amino acid or protein that comes from wheat, dairy and oats. Malnutrition of this amino acid can cause red hair. I had an acquaintance who adopted a child in Iran. The child was a redhead who suffered from malnutrition. After a few months of proper nutrition, the child turned from a redhead into a brunette! Have you ever heard of red fur syndrome in black cats? Cat food with higher contents of phenylalanine will usually solve the problem.

Sulfur and Other Minerals
Levels of sulfur compounds such as glutathione and cysteine and minerals such as copper, zinc and iron are important components to the production of red/yellow pigment. Higher levels of these substances may cause increased production of lighter pigment over darker pigment. Since redheads are genetically short-wired to predominantly produce red/yellow pigment, which oxidizes easily and needs to be replaced frequently, they will more than likely use up more glutathione or cysteine in their pigment production. Taking a multi-vitamin/mineral supplement along with N-Acetyl-L-Cysteine supports proper pigment production for the fair-skinned and benefits the skin, hair, as well as the liver.

Lack of Proper Tools: The assembly lines, or melanosomes, need specific proteins and enzymes to produce pigment from the raw materials. Lack of these proteins or enzymes can cause red/yellow pigment to be produced or can even cause albinism or a lack of pigment.

A brief digression.....
I wish that I could go back to the age of 10 with this scientific knowledge and debate this point with a boy called Eric. Eric had gotten into the habit of calling me an albino during our many carpools to church youth club. As he would insult me, he would also recline the front car seat onto my knees as I sat in the back seat. Apparently, infuriating me at this age was entertaining to him and others. Eric was (and likely still is) one of those super-geeks who the teachers allowed to set off rockets in the playground as the entire school gathered around and watched in anticipation. Rumor had it that he had an FBI record in his teens for trying to build a bomb with his chemistry set; however, it seems that this rumor might bear some merit as the source was my high school chemistry teacher. Eric was very likable and popular in his geek-dom. I would even go as far as to say that he had a bit of a Spock-like appeal, which was particularly evident in his brow and his manner of speaking. He used to memorize his fellow band members' license plate numbers and recite them for fun, "Kymie, 3RNK036". I remember confronting him about the albino comment later on. To which he replied that ladies used to put arsenic in their tea to make their skin appear as porcelain as mine. Was this his geeky way of flirting with me?

anyway back to the assembly line....
Size of Assembly Lines or Melanosomes: The bigger the assembly lines, the more dense and darker the pigment. Those who have darker skin genetically have bigger melanosomes.

Old Dilapidated Factories: Old melanocyte cells that do not operate properly tend to produce gray hair. Gray hair occurs when melanocyte cells within hair follicles stop producing melanin. Scientists don’t know really know why hair turns gray for some especially as they grow older, but they believe it is based on genetics inherited from parents. It is possible that a thyroid problem, vitamin deficiency, and smoking can accelerate hair turning gray as one gets older.

The Assembly Line Environment: Darker pigment requires an alkaline pH within the melanosome; whereas, lighter pigment requires a more acidic environment. When you are sick, the melanosomal environment tends to become more acidic and your skin becomes a sickly pale.

The Message Itself: A genetic lack of the proopiomelanocortin hormone (POMC), the precursor or prohormone to alpha-MSH, will cause production of red/yellow pigment, adrenal insufficiency, and early onset obesity

The Message Gets Blocked: The agouti-signaling protein intermittently blocks or intercepts the message that goes to the factory managers, but this seems to only apply in mice, not in humans.

Phew! Who knew that red hair was so complicated? Well, I knew and so did you. And I'm glad that science is finally catching up and helping us understand ourselves better. You are all beautiful complicated mutations of nature, and I love you all.