An unprecedented number of studies are pouring in detailing the failings of the healthcare system. From financial inequalities linked to over inflated health insurance rates and deductibles, to racism affecting the person-to-person treatment within the hospital walls, serious issues are being uncovered.
One such serious issue coming to light is women, and women of color, especially, who are being undertreated for pain in the emergency room. After major surgeries, women are half as likely to be prescribed pain relievers as men, add in race variables, and outcomes are even worse.
While the opioid epidemic rages on around us, and access to pain medicine is in constant review, how is it that women are being denied basic access to appropriate pain relieving medications?
Why Are Women Being Under Prescribed Pain Relievers?
According to the BBC, in 2018, when women go to the hospital seeking treatment for pain, they are much more likely than men to receive sedatives, rather than pain medication. Additionally, women who underwent coronary bypass surgery were only half as likely to be prescribed pain relief as men.
Not only are women under prescribed pain medication both in emergent and post operative situations, but women wait, on average, 65 minutes before receiving medication while men wait 49 minutes—indicating their pain is taken much more seriously, as they get more medications, more quickly.
A 2020 study published in the American Heart Association’s flagship journal, Circulation found that women face a 20 percent increased risk of developing heart failure or dying within five years after their first severe heart attack, compared to men.
The simple reason behind this? The medical understanding of most diseases are based on male physiology and, unfortunately, women have altogether different symptoms than men during a heart attack.
The medical system has other gender biases which can have serious and, often fatal, repercussions for women.
Women make up 70 percent of those suffering from chronic pain, yet 80 percent of pain studies are conducted on male mice or human men. One of the few studies to research gender differences in the experience of pain found that women tend to feel it more of the time and more intensely than men.
While the exact reasons for this discrepancy haven’t been pinpointed, biology and hormones are suspected to play a role.
There are four areas that women experience more pain in, and much of the research available is globally relevant. This has to do with hormones, puberty, reproductive status, and menstrual cycle, which also affect the pain threshold and perception.
- Musculoskeletal pain
Musculoskeletal pain, when chronic, is more prevalent in women than men.
In fact, one study coming out of the Hong Kong Mood Disorders Center that spanned 17 countries, on six continents, with more than 85,000 participants, showed that the occurrence of chronic pain is higher among females than males.
The specific types of musculoskeletal pain studied included back pain, whole body pain, fibromyalgia, and osteoarthritis. Any one of these conditions puts women at a higher risk of breaking a bone during a fall, which can further add to any pain.
- Abdominal pain
A number of studies have found a higher prevalence of abdominal pain in women.
The National Library of Medicine (NIH) reports that there is approximately a 3-to-1 female-to-male ratio in the diagnosis of irritable bowel syndrome in the United States. This condition is characterized by recurring symptoms of abdominal pain and problems with bowel habits.
Headaches are one of the most common pain conditions. One review of findings from more than 60 studies concluded that the prevalence of headaches and migraines are higher for women than men.
In the NIH American Migraine Study II, which included more than 29,000 adults, it was estimated that 18 percent of women experienced one or more migraines over a one-year period, compared to 7 percent of men.
According to the Women’s Health Office of the U.S. Department of Health and Human Services, migraines are most common in women between the ages of 20 and 45. Women report more painful and longer-lasting headaches, with increased associated symptoms, including nausea and vomiting.
- Pelvic pain
For women suffering from chronic pelvic pain, absent a physical injury, childbirth or identifiable procedural cause, there is significant potential for a history of intimate partner violence.
According to the Centers for Disease Control and Prevention, 1-in-4 women in the U.S. have experienced intimate partner violence, physical violence, or rape compared to 1-in-7 men. Data suggest that this can contribute to pain conditions.
Gender Stereotypes and Pain Management
In a recent study published by the Journal of Pain, co-authored by Elizabeth Losin, assistant professor of psychology and director of the Social and Cultural Neuroscience lab at the University of Miami, researchers found that a patient’s pain responses may be perceived differently by others based on their gender.
Overall, the study found that female patients were perceived to be in less pain than the male patients who reported, and exhibited, the same intensity of pain.
Additional analyses using physicians’ responses to the questionnaire about gender-related pain allowed researchers to conclude that their perceptions were, in fact, at least partially explained by gender stereotypes.
The stereotype is to think of women as more expressive than men. If it is thought that a woman is ‘overly’ expressive, then her pain behavior is more easily discounted. On the other side, if the stereotype toward men is to think they are more stoic, then less of a reaction on their part garners better healthcare and adequate pain management.
The result of this gender stereotype regarding pain expression is that each unit of increased pain expression from a man is thought to represent a higher increase in his pain experience, than that same increase in pain expression by a woman.
What’s more, psychotherapy was chosen as a more effective treatment than medication for a higher proportion of female patients, compared to male patients.
Additionally, the study concluded that the gender of the physicians involved did not influence pain estimation. Both men and women interpreted women’s pain to be less intense.
What are the Lasting Effects of Untreated Pain?
Untreated acute pain has a profound impact on quality of life and can have physical, psychological, social, and economic consequences. Inappropriately managed acute pain can result in immunological and neural changes, which can progress to chronic pain if untreated.
Clinical outcomes of untreated postoperative pain include increased risk of atelectasis, respiratory infection, myocardial ischemia, infarct or cardiac failure, and thromboembolic disease. Common consequences of untreated chronic pain include decreased mobility, impaired immunity, decreased concentration, anorexia, and sleep disturbances.
Patients with chronic pain often experience social isolation, dependence on caregivers, and impaired relationships with friends and family, and are four times more likely to experience depression or anxiety than those without pain.
The financial burdens of untreated chronic pain—absenteeism, income loss, healthcare costs, and workers compensation—place the same economic strain on countries as cancer and cardiovascular disease.
In the United States, the annual cost of untreated pain is reported to be between US$560–US$635 billion.
Can a Physician Be Held Liable for Under Treating Pain?
Studies detailing the undertreatment of pain in women began to emerge in 2001 and the first pain mismanagement malpractice case reached the courts in Los Angeles, CA that same year. By a nine to three vote the jury decided that the physician’s lack of attention to pain constituted elder abuse, and awarded the family $1.5 million.
The case was brought to court three years after an 85-year-old man with metastatic lung carcinoma spent the last week of his life in severe pain. The suit was based on the idea that the treating physician had failed to prescribe drugs powerful enough to relieve the patient’s pain.
There is much evidence suggesting women who report having acute or chronic pain are less likely to be given painkillers than men. If they are prescribed, women will also wait longer to receive them.
Overall, women have been more often referred to psychologists or psychiatrists, rather than given appropriate treatment and pain management.
Pain management is an important part of health care. A physician who does not manage a patient’s pain properly can be found negligent. There are clear guidelines and standards when it comes to pain management, and when those standards are not met, people suffer unnecessarily—most notably women and people of color.
Furthermore, failure to properly treat pain can have lasting and devastating effects on a person’s quality of life if left untreated.
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