Legislature Examines Gender Bias in Pain Management

Feb 05, 2004
Carlota Gutierrez - (916) 445-6671

Women’s pain often discredited

(Sacramento, CA) During a legislative hearing, chaired by Senator Liz Figueroa (D-Fremont), examining how chronic and debilitating pain afflicts men and women differently, legislators were shocked to learn the severity of gender bias on the part of practitioners surrounding the treatment of pain.

In collaboration with the Senate Health and Human Services Committee and as chair of the Legislative Women’s Caucus, Figueroa led the informational hearing with the goal of educating the public on the significant inequities towards the diagnosing and treatment of pain suffered by women as compared to men.

“Across the board, chronic pain in this country is largely under-treated, but women pain patients face an additional barrier to proper treatment and diagnosis,” said Figueroa. “Pain has long been considered a troublesome female complaint rather than a legitimate symptom that something is physically wrong. Social and cultural barriers continue to discredit a woman’s pain as emotional, psychogenic and therefore not real, and in response physicians are more likely to prescribe women sedatives to ‘calm their nerves’ rather than actually treat the pain.”

The research and medical world has long been a male dominated environment, which has fostered a well-entrenched, little recognized inequity in the world of pain management. While studies show biological and psychological differences in how males and females perceive and respond to pain, these differences hardly account for the discrepancies in physician ordered treatment of pain.

Leading advocate for pain patients Cynthia Toussaint, who suffers with the Reflex Sympathetic Dystrophy, has seen a growing awareness towards women in pain, however, a gulf of inequities still exist. During the years prior to her diagnosis, physicians told Cynthia she was “suffering stage fright” and one doctor even suggested suicide. “All of this abuse was framed by a constant reminder that I was only a woman anyway—it didn’t matter.“ testified Toussaint. “This is a healthcare crisis, and sanctioned torture, that has been ignored for far too long…we must educate our health practitioners and medical students to simply believe a woman when she reports she is in pain.”

Renowned professor Diane Hoffmann, Associate Dean at the University of Maryland School of Law, acknowledges there is no solid objective measure for pain and patients’ descriptions are subjective. Yet her 2001 study, published in the Journal of Law, Medicine and Ethics, and titled ‘The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain’ found that women’s pain is taken less seriously and women receive less treatment than men do.

In addition, women are often viewed as less accurate reporters of their pain. This perception has been debunked by a National Academy of Sciences study showing a patient’s subjective description of their pain is an accurate indication of the degree of pain they are experiencing.

Dr. Scott Fishman, Chief of the Division of Pain Management at the U.C. Davis Medical Center, attributes the gender discrepancy to a larger problem; the unwillingness of physicians to prescribe needed pain medication due to fears of patient addiction. “When someone has cancer it is worth the risk of prescribing radiation and chemotherapy, essentially poison,” testified Fishman. “But, when someone is in pain it is somehow not worth the risk of prescribing needed pain medication.”

Some in the medical community attribute the problem to biases on the part of the health insurance industry. “Insurance companies are more willing to pay for expensive and often unnecessary procedures rather than pay for a physician to spend the necessary amount of time with the patient to properly diagnose the problem,” testified Dr. Steven Richeimer, Director of the USC Pain Management Department. “When the patient is a woman, it’s that much easier for the insurance company to deny proper treatment.”

Chronic pain refers to a host of debilitating conditions that afflict nearly 50 million Americans and 45% of all Americans seek care for persistent pain at some point in their lives. These illnesses include common medical problems such as arthritis and migraine headaches as well as other conditions such as Reflex Sympathetic Dystrophy, Interstitial Cystitis, Ehlers Danlos Syndrome and Lupus that go largely under-diagnosed.

“It is absolutely necessary that we continue to examine this issue and find solutions. Pain is a human condition and generally treatable. Women, and men, are suffering needlessly and that is intolerable,“ concluded Figueroa.