1) Mood and Affect

While it may seem intuitive to assume that prolonged pain impacts mental health, research shows that depression and anxiety can predict the later development of chronic pain. In chronic pain sufferers, mood disorders and emotional distress have been found to impact health outcomes even more than the intensity of pain itself. Given the strong role mood disorders play in the development and persistence of pain, the higher rates of depression and anxiety in women may help explain why chronic pain is more common in women than in men.

Classic psychedelics—including psilocybin, DMT, and ayahuasca—have been shown to improve symptoms of depression in several clinical trials. Interestingly, participants also reported unexpected relief from comorbid chronic pain, likely due to disruptions in neural pathways shared by mood disorders and chronic pain. These same networks are thought to underlie the therapeutic effects of psychedelics.

In addition to mood disorders, women are more likely to exhibit pain catastrophizing, the tendency to ruminate on pain and anticipate the worst outcomes. Pain catastrophizing strongly contributes to the chronification of pain, whereas positive emotions and optimism can reduce pain perception by counteracting catastrophizing. This suggests that microdosing, which enhances mood and alleviates depression, may be a promising therapeutic approach for chronic pain.

However, realizing this potential requires more inclusive research. Despite mood disorders and chronic pain being more prevalent in women, men remain overrepresented in clinical trials, including psychedelic studies, leaving key questions about sex-specific effects and risks unanswered.

2) Trauma

Childhood trauma increases the risk of developing chronic pain later in life, particularly for conditions more common in women, such as fibromyalgia, irritable bowel syndrome, chronic pelvic pain, and temporomandibular joint pain. Girls are more likely than boys to experience sexual and emotional abuse, both of which are linked to chronic pain in women but not in men.

This pattern of abuse continues into adulthood, with women more likely to experience sexual abuse and gender-based violence. Such high-impact traumas increase the risk of post-traumatic stress disorder (PTSD), which is significantly more prevalent in women. PTSD sufferers often develop chronic pain, with evidence showing that PTSD can trigger unexplained pain in adults with a history of childhood trauma. These statistics help explain why chronic pain is more prevalent in women, whose life experiences differ fundamentally from men’s.

Building on findings that MDMA-assisted therapy alleviates PTSD, new studies show that psilocybin and ayahuasca therapies in retreat settings improve mental health, with women showing greater PTSD relief than men. Since chronic pain is rooted in social dysregulation, healing in community-based settings like psychedelic retreats may be especially beneficial. Ensuring these spaces are safe for women is essential, given the role of trauma in pain and the risk of retraumatization—a key concern explored in depth by Hystelica.

3) Social Interactions and Gender Roles

Social interactions significantly shape our perception of pain. For instance, insecure attachment styles—whether in individuals with chronic pain or their partners—have been linked to increased pain. Conversely, a clinical trial involving mostly female participants found that including spouse support in a pain management program reduced pain catastrophizing and intensity more effectively than patient-oriented care alone. However, excessive support or solicitous behavior may worsen pain by undermining an individual’s sense of self-sufficiency.

The relationship between gender and pain is established early in life: girls are socialized to express emotions and seek comfort, while boys are taught to avoid appearing vulnerable. Consistently, boys and men report higher acute pain tolerance in the presence of male peers, whereas women report greater acute pain sensitivity when accompanied by intimate friends or partners. This may be explained by pain catastrophizing, viewed as a learned coping strategy that elicits support and empathy from loved ones. As a result, women are more likely to report pain and seek help early.

The urgency to resolve pain reflects the complex social roles women occupy—balancing work, caregiving, domestic life, and social responsibilities. Because pain catastrophizing is more common in women, healthcare practitioners often disregard women’s pain. This bias extends beyond clinical settings; studies show observers rate girls’ pain as less severe than boys’ pain, reinforcing societal tendencies to dismiss women’s suffering. Expecting adequate support predicts better clinical outcomes, so the dismissal of women’s pain may reinforce helplessness and prolong chronic pain.

Receiving the right amount of support from a trusted community in a guided setting may help break this cycle. Across indigenous traditions and modern practices, psychedelic substances are rarely used in isolation. Rituals and ceremonies create communitas, a state of profound connectedness and shared humanity free from social roles and hierarchies. This raises important questions:

1. Might group psychedelic sessions offer greater benefits than one-on-one formats used in most chronic pain trials?

2. Could group-based approaches benefit women more?

3. What group gender composition best supports women?

Psychedelic Therapies and Chronic Pain in Women

Viewed through a psychosocial lens, chronic pain is a complex process shaped by damaging thoughts and rigid beliefs formed through personal and social experiences. This does not mean the pain is imagined: chronic pain involves physical changes such as altered brain wiring, spinal cord dysregulation, sensory neuron changes, and inflammation.

Psychedelics interact with all dimensions of pain, from molecular pathways and brain-wide connectivity to mental processes and social dynamics—factors that manifest uniquely in women. The resurgence of psychedelic therapies provides a powerful opportunity to rethink chronic pain treatment, centering women, who represent the majority of those affected, rather than treating them as deviations from the male norm.