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The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain

Published online by Cambridge University Press:  01 January 2021

Diane E. Hoffmann  and
Anita J. Tarzian
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Extract

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”

Genesis 3:16

There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their pain.

One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 29 , Issue 1 , Spring 2001 , pp. 13 - 27
Copyright
Copyright © American Society of Law, Medicine and Ethics 2001

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Hadjistavropoulos, , McMurtry, , and Craig, , supra note 69; Hadjistavropoulos, , Hadjistavropoulos, , and Craig, , “Appearance-Based Information about Coping with Pain: Valid or Biased?,” supra note 71; Hadjistavropoulos, , Ross, , and von Baeyer, , “Are Physicians' Ratings of Pain Affected by Patients' Physical Attractiveness?,” supra note 71.Google Scholar
See Selfe, S.A., Matthews, Z., Stones, R.W., “Factors Influencing Outcome in Consultations for Chronic Pelvic Pain,” Journal of Women's Health, 7, no. 8 (1998): 1041–48.Google Scholar
In a Connecticut focus-group study with chronic pain patients, participants reported visiting multiple physicians (quoting “60 to 100”) in order to find a diagnosis and a practitioner with whom they felt comfortable. See Grantham, S. and Robbins, M., The Connecticut Pain Management Initiative: Focus Group Report (Boston: John Snow, Inc., February 11, 2000).Google Scholar
Marshall, , supra note 92.Google Scholar
About 55 to 65 percent of those who consult complementary practitioners are women, the highest users being those aged 35 to 60. See Zollman, C. and Vickers, A., “ABCs of Complementary Medicine: Users and Practitioners of Complementary Medicine,” British Medical Journal, 319, no. 7213 (1999): 836–38; and Ernst, E., “Prevalence of Use of Complementary/Alternative Medicine: A Systematic Review,” Bulletin of the World Health Organization, 78, no. 2 (2000): 252–57.Google Scholar
Controversy over use of the term “alternative” rather than “complementary” medicine demonstrates the point being made here. The former describes therapies that are not sanctioned by conventional medicine and which patients choose instead of conventional medical therapy. The latter views such therapies as complementing conventional medical therapies. The goal would be for women (as well as men) to have access to both traditional and non-traditional therapies for pain management, with a focus on a holistic approach that provides optimal pain relief. This holistic approach is the accepted standard for many pain clinics and inpatient pain teams, but adequate access to such care is limited for many individuals — either because the pain teams and clinics are not available in their area or they do not get the referral they need.Google Scholar
Davidson and Freudenberg conclude that women in general, as a result of their socialization, are not as likely to develop a distinction between themselves as individuals and the world around them, whereas men are socialized to objectify and control their environment and to define themselves as separate from the world around them. Men would thus be more apt to try to separate biological and psychosocial pain etiologies, whereas women would tend to view them more holistically. See Davidson, D.J. and Freudenburg, W.R., “Gender and Environmental Risk Concerns: A Review and Analysis of Available Research,” Environment and Behavior, 28, no. 3 (1996): 302–39. This theory is affirmed by Bendelow's findings that women spoke of pain experiences more holistically as compared to men and that “men were significantly less inclined to think that the emotional component of pain perception had any importance.” See Bendelow, , supra note 32, at 90.Google Scholar
See Kwolek, D.S. et al., “Gender Differences in Clinical Evaluation: Narrowing the Gap with Women's Health Clinical Skills Workshop,” Academic Medicine, 73, no. 10 (supplement) (1998): S88–90.Google Scholar
That is, women may: (1) have their pain complaints erroneously dismissed as being emotionally-based and therefore “not real” when there is no significant psychological component to the pain; (2) have the likely psychological components that accompany chronic pain be misidentified by health-care providers as the cause, rather than the result of their unrelieved pain, leading to a discounting of the pain; or (3) have the psychological problem that is the source of their pain be discounted and not adequately addressed. All three are inappropriate and reveal a disdain for psychosocial contributors to pain over evidence of organic causation. See Duncan, , supra note 33.Google Scholar
Bendelow found that men who were given an opportunity to discuss the emotional aspects of their pain experiences did so and were grateful for the opportunity, even though they did not initially acknowledge emotions as contributing to their pain. See Bendelow, , supra note 32, at 90–94.Google Scholar
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Some institutions have already begun addressing the impact of JCAHO pain management standards. See Pasero, C., McCaffery, M., and Gordon, D.B., “Build Institutional Commitment to Improving Pain Management,” Nursing Management, 30, no. 1 (1999): 27–33.Google Scholar