New research is adding to the growing body of work that indicates women’s experience of pain is viewed with more skepticism than men’s.
The study, published this month in the Journal of Pain, looked at how average adults (not clinicians) perceive men and women’s expression of pain.
The first phase of the study had participants watch video clips of men and women expressing various levels of shoulder pain. When the researchers controlled for facial expressions and self-reported pain, patients perceived to be female were generally rated to be in less pain than the males.
When participants were asked to predict the level of pain the subjects of the video were in before watching on a scale of 0-100, participants were more likely to overestimate how much pain the men were in, and underestimate how much pain the women were in compared to the self-assessment.
The second phase of the study recruited participants online and asked them to suggest treatment options for the men and women in the pain videos. Medication was prescribed for 62 per cent of cases involving men and 58 per cent of cases involving women, while psychotherapy was prescribed for 42 per cent of females versus 38 per cent of males.
The second phase also evaluated the effect of gender stereotypes on pain perception. Women rated other women as having a higher pain tolerance than men and both men and women rated women as more likely to report pain. Not surprisingly, participants who rated men as having high pain tolerance also rated men in the videos as experiencing more pain and prescribed pain medication more often. The participants who rated women as having a high pain tolerance, however, still underrated women’s perceived pain and did not prescribe pain medication more often than the men.
Gender differences in pain management
Decades of research indicate that pain is treated differently in men and women. Men who report specific pain are generally given tests that directly relate to their pain or are prescribed pain medication. Women, on the other hand, reporting the exact same pain are more likely to be given general diagnoses — rather than specific diagnoses directly relating to the pain they were reporting — or to be referred to therapists.
In 2002, a national exam for medical interns in Sweden (41 per cent of whom were women) included two variations of a question revolving around suggested treatment for reported neck pain. In one variation the patient was male, in the second variation the patient was female — all other factors in the question were identical. Laboratory tests were more often prescribed for the male patient, while answers to the question involving the female patient were more likely to consider nonspecific somatic diagnoses, recommend psychosocial questions, and request support from physiotherapists and orthopedists.
A separate study in 2014 suggested that female physicians were more likely to prescribe antidepressants and a mental health referral to female patients complaining of pain than male patients. (This study didn’t find a significant difference in how male physicians treated female and male patients in regard to pain.) This relationship held true even when the researchers controlled for sexist attitudes, measured through a questionnaire.
In 2016, yet another study, conducted by researchers in British Columbia and London, suggested that women complaining of pain were more likely to be recommended psychological treatment, while men were more likely to be prescribed pain killers. These results held even after the researchers controlled for levels of empathy the diagnosing clinicians had towards the patients.
Men being more likely to be prescribed pain killers rather than other forms of treatment, like cognitive pain management classes, also has dizzying ramifications: Men are more likely to develop a substance abuse disorder — including dependence on prescription pills — even though both men and women are equally susceptible to addiction, according to a research report by the US National Institute of Health.
Working with your healthcare team
When working with a doctor to come to a diagnosis and treatment plan, asking why is a powerful tool to understand the reasons behind a diagnosis (or lack of one) and to ensure the physician understands what you are experiencing. Other questions you can ask include “what should I do if the symptoms get worse?” and “what else could explain these symptoms?” Symptom trackers (including apps and websites) may help patients report everything they are experiencing to their doctors.
Also remember there is no shame in reporting symptoms that may feel embarrassing, like rectal pain or pain during sex. Ensuring a doctor has all of the pertinent information will help make a proper diagnosis.
If in doubt, don’t be afraid to seek out a second opinion. Serious pain is not normal and should be taken seriously by your healthcare team.
Don’t miss the latest on COVID-19, reopening and life. Subscribe to Healthing’s daily newsletter COVID Life.