A few weeks ago, I cared for a red-haired lady who underwent a bowel resection. After surgery she felt anxious and irritable regarding her pain control, watching her pain regimen like a hawk & making sure her nurse was giving her narcotics on time “so that her pain control did not fall behind”. She started getting drowsy so we had to cut back on narcotics. When I asked her about it she said, “I am a redhead, I have always felt more pain”. So I went down the PubMed rabbit hole to find answers – is low pain tolerance in Redheads a myth or reality?
What I found was that red-haired people indeed respond to pain differently than the rest. A study in 2004 showed redheads needed significantly higher amounts of inhaled anesthetic doses. However in this study, post-op recovery in terms of time, pain score was no different compared to non-redheads. Another study published in 2005 showed higher sensitivity to thermal pain & reduced efficacy of subcutaneous lidocaine in redhead women. Research to understand the precise mechanism is ongoing – the answer appears to lie with the mutations in the melanocortin11 receptor (MC1R) gene found on the surface of Melanocytes (Pigment-producing cells). Receptor activation would prompt the production of Eumelanin which bestows darker color to skin & hair, while in red-heads the mutated receptor does not and makes a default yellow-red Pheomelanin instead. A study using red-haired mice published in 2021 showed how the same MC1R receptor mutations result in these cells producing lower proopiomelanocortin and reducing Melanocyte Stimulating Hormone levels, which appears to play into increasing pain tolerance threshold but enhancing sensitivity to opioids.
Asking my patient more questions, indeed her “always felt more pain” was in the context of dental procedure experiences. Is it possible that not getting enough anesthetic during dental procedures caused her to feel more pain and not a lower pain threshold?
💡 Note that red-haired patients may need higher topical and general anesthetic doses, but they are actually likely to have a higher sensitivity to opioids and need careful dose titration and monitoring to avoid overdosing. We can’t say for sure about pain tolerance levels yet, but they can be anxious regarding pain control due to pervasive general/popular impressions regarding low pain tolerance (which may be incorrect so avoid that bias) and past anxiety regarding experience with inadequate anesthesia. Reassuring their anxiety regarding pain control would be an important component of analgesia.
The Redhead of Auschwitz: A True Story on Amazon (#Adlink)
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