Gender and Pain Management
There is a growing body of literature that indicates women are more likely than men to be undertreated for their pain.
It appears that gender affects not only pain perception, pain coping, and pain reporting, but also pain-related behaviors, including use of healthcare and the social welfare system. It is also probable that men and women differ systematically in their responses to pain treatments, although further research is needed in this area.
For many common pain conditions, including migraine and tension-type headache, facial pain, and abdominal pain, population-based studies indicate higher prevalence rates in adult women than in adult men.1
Despite the difficulties with human laboratory experiments on pain sensitivity, many investigators are willing to draw the inference from these studies that women are, in general, more sensitive to painful stimuli than men, and that this difference is biologically based.2, 3
Whatever the pain prevalence differences for men and women, most studies show that women seek healthcare for pain at a higher rate than men4:
- One study indicated that women are more likely to be given sedatives for their pain, while men are more likely to be given pain medication.5
- Faherty and Grier studied the administration of pain medication after abdominal surgery and found (after controlling for weight) that physicians prescribed less pain medication for women than for men ages 55 or older, and that nurses administered less pain medication to women than to men ages 25-54 years.6
- Beyer et al examined pain medication given to children and found that, after surgery, boys received significantly more codeine than girls, and girls were more likely than boys to be given acetaminophen.7
- In a 1994 study of 1,308 outpatients, Cleeland and colleagues found that women with metastatic cancer were significantly more likely than men with the same diagnosis to receive inadequate pain medications.8
- In a study of several hundred AIDS patients, Breitbart and colleagues found that, based on the WHO analgesic ladder guideline, women were significantly more likely than men to receive inadequate analgesic therapy.9
- A study by Weir and colleagues found that women are less likely than men to be referred to a specialty pain clinic, at least upon initial encounters with their physicians.10
- A study reviewing cancer care at seven outpatient clinics in California found that female cancer patients were prescribed half the pain medication as male patients with the same pain intensity scores.11
- Males outnumber females two to one in the burn population. This is related to male household and job roles, which increase the risk for burn injury. Furthermore, males more commonly engage in risk-taking behaviors involving chemicals, flammable materials, or electricity.12
Studies have shown differences in the attitudes of healthcare providers toward men’s and women’s experiences of pain.
- McCaffery and Ferrell, using a questionnaire administered to more than 300 nurses, found that most respondents believed that women, compared to men, were less sensitive to pain, more tolerant of pain, less distressed as a result of pain, and more likely to report pain and express pain through nonverbal gestures.14
- Regarding physician perceptions of female patients with pain, Hadjistavropoulos and colleagues found that physicians distinguished between their “attractive” and “unattractive” patients. Attractive female patients were perceived as experiencing less pain than unattractive female patients, evidencing a “healthy is beautiful” stereotype.15
- Historically, the medical literature has portrayed women as hysterical and oversensitive. By extension, physicians often view women’s statements as emotional, rather than objective. In one study of patients with chronic pain, female patients were more likely than their male counterparts to be diagnosed with histrionic disorder, excessive emotionality, and attention-seeking behavior.16
- According to an analysis of recent pain research by Hoffmann and Tarzian, women are more likely than men to seek treatment for their pain and are less likely to receive it. The authors suggest that physicians may treat women less for pain based on the presumption women can handle more pain or, conversely, that women are in fact imagining pain where none exists.17
International Association of the Study of Pain
IASP Secretariat, 909 NE 43rd Street, Seattle, WA 98105, Phone: (206) 547-6409
National Women’s Health Resource Center
120 Albany Street, Suite 820, New Brunswick, NJ 08901, Phone: (877) 986-9472
- LeResche L. "Gender considerations in the epidemiology of chronic pain." In: Crombie IK, Croft PR, Linton SJ, et al, eds. Epidemiology of Pain. Seattle: IASP Press; 1999:43-52.
- Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997;20:371-380.
- Fillingim RB, Maixner W. Gender differences in the response to noxious stimuli. Pain Forum. 1995;4:209-221.
- Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65:123-167.
- Calderone KL. The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles. 1990;23(11-12):713-725.
- Faherty BS, Grier MR. Analgesic medication for elderly people post-surgery. Nurs Res. 1984;33(6):369-372.
- Beyer JE, DeGood DE, Ashley LC, et al. Patterns of postoperative analgesic use with adults and children following cardiac surgery. Pain. 1983;17(1):71-81.
- Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330(9):592-596.
- Breitbart W, Rosenfeld BD, Passik SD, et al. The undertreatment of pain in ambulatory AIDS patients. Pain. 1996;65(2):243-249.
- Weir R, Browne G, Tunks E, et al. Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used. Clin J Pain. 1996;12(4):277-290.
- Gender disparities seen in cancer pain treatment. Oncol News Int. 2001;10(5):58.
- Maaser B. Early psychological interventions with adult burn survivors and their families. Top Emerg Med. 1995.
- McCaffery M, Ferrell BR. Does the gender gap affect your pain-control decisions? Nursing. 1992;22(8):48-51.
- Hadjistavropoulos T, McMurty B, Craig KD. Beautiful faces in pain: Biases and accuracy in the perception of pain. Psychol Health. 1996;11(3):311-420.
- Fishbain DA, Goldberg M, Meagher BR, et al. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986;26(2):181-197.
- Hoffmann DE, Tarzian AJ. The girl who cried pain: a bias against women in the treatment of pain. J Law Med Ethics. 2001;29:13-27.