Research Confirms What Women Already Know About Sex Bias in Pain Care

By Crystal Lindell

There’s a new study showing that doctors take pain reported by male patients more seriously than female patients. And I have to say – why are we still doing studies on this? 

Anybody who’s been paying attention already knows this is the case. We have known it’s been true for decades. What we actually need are studies on what can be done to effectively fix this sex bias. 

For the sake of relaying this important information one more time though, let’s look at the study, which was published in the journal PNAS. The researchers did an analysis of emergency room patient data in the U.S. and Israel, which showed that there is medical bias against female patients in pain management decisions.

They analyzed more than 21,000 patient records and found that female ER patients across every age group were consistently less likely to receive pain medication compared to male patients with similar complaints. 

Depressingly, this bias persists across different ages, pain levels, and even physician gender. Which means female doctors are just as guilty as male doctors.

"This under-treatment of female patients' pain could have serious implications for women's health outcomes, potentially leading to longer recovery times, complications, or chronic pain conditions,” says Shoham Choshen-Hillel, PhD, Associate Professor at The Hebrew University of Jerusalem.

Yeah – and pardon my French here, but – no shit. Like I said, anyone who’s been paying attention has known this for a long time. Many of us have already been living with the so-called “serious implications.” 

Way back in 2014 – a full decade ago – I wrote about my experiences as a woman in pain. At the time, I wrote: 

“Being in pain every day, all day, is hard. But when you’re a woman, there’s a whole extra layer to the situation that makes everything that much harder… 

Like did that male doctor just give me Aleve for my level-10 pain because he really thinks that’s going to help? Or did he just think that, as a woman, I was probably exaggerating?”

Now that I’m 10 years older, and 10 years more experienced as a patient with chronic illness, I can answer my own question: Yes. He definitely thought I was exaggerating. 

But I’m not the only one who’s been talking about sex bias in pain care for a long time. 

The advocacy organization for women in pain, “For Grace” was founded in 2002 – more than 2 decades ago! Their mission is “to increase awareness and promote education of the gender disparity women experience in the assessment and treatment of their pain.” 

A 2001 study of gender bias in the Journal of Law, Medicine & Ethics was given the headline "The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain." 

And here's another one from the last century (1996) in The Journal of the International Association for the Study of Pain titled, "Gender variations in clinical pain experience"

The fact that female pain isn’t taken as seriously as male pain is not new! 

Solutions Needed

Researchers behind the latest study do call for solutions, asking for “urgent policy interventions to address this bias and ensure equal pain treatment regardless of sex.” 

Specifically, they recommend training programs for healthcare professionals to recognize and counteract sex bias, and say pain management protocols should be revisited to ensure fair and adequate treatment for all patients.

All great ideas. But not really new ones. 

Now we need new training programs to undo the ingrained patriarchal bias among doctors. Because whatever they’ve been trying clearly isn’t working. 

Continuing to do more and more research showing that what women have been complaining about for decades is true doesn’t help anyone. We need solutions. 

This is where I’m going to get a little bit radical. Because personally, when it comes to pain treatment, I already have a very good solution: A lot more pain medication needs to be sold the same way alcohol is – over the counter. We cannot trust doctors – even female doctors – to give it to women when we need it.

This would not solve the problem of female pain being ignored, but it would at least provide some immediate relief for women, as well as others, who often have their pain ignored because of sexism, cultural bias, racism and classism. 

This is also a large part of why I believe pain control and access to pain medication is a “my body, my choice” issue. Until we have medical training that can actually undo thousands of years of sexism, we should all have the legal right to treat our own pain when doctors refuse to take it seriously.  

In the meantime, we don’t really need more studies showing that there’s a sex bias in pain treatment. They’re essentially a waste of time at this point. What we need are solutions to a problem that millions of people have been aware of for a very long time.

Sex Bias Persists in Pain Research

By Pat Anson, PNN Editor

It’s long been known that women are more likely than men to have chronic pain conditions such as fibromyalgia, rheumatoid arthritis, irritable bowel syndrome (IBS) and migraine. Women are also more likely to feel more severe, recurring and longer lasting pain.

Why then are women less likely to receive pain treatment? And why are some treatments less effective for women?

One obvious reason is that men and women have different biology and process pain differently. Another is a “blind spot” in pain research, which is more focused on studying males than females, according to a new review published in the journal Nature Reviews Neuroscience.

"The pain literature is biased such that, because of the overwhelming use of male animals in experiments, we are increasingly learning about the biology of pain in males. And wrongly concluding that this is the biology of pain. It's only the biology of pain in males," says author Jeffrey Mogil, PhD, a Professor of Psychology and Anesthesia at McGill University in Montreal.

Mogil reviewed over 1,000 research articles published in the journal Pain between 2015 and 2019, and found a distinct change in the sex of laboratory animals used in research. In 2015, for example, 80 percent of the studies only used male rodents. By 2019, half of studies were male-only.

SOURCE: Nature Reviews Neuroscience.

The trend towards using both male and female animals may sound like a promising change in research design. But when Mogil looked more closely at sex differences in pain literature, he found clear evidence that a male bias still exists in pain research.

"The very ideas we come up with for experiments, are based on experiments in males and therefore they work in males and not in females,” says Mogil.

Even in studies that included both male and female rodents, Mogil found that the research was often geared toward the males’ response. In experiments that “worked out” -- meaning the scientific hypothesis being tested was found to be true -- over 72% of the male rodents had a positive response, while only about 28% of the female rodents did. That strongly suggests the research was biased even before the experiments began.

"If there were no bias in the literature and there were a number of papers where the experiment worked in one sex and not the other, it should work in females just as often as in males,” explained Mogil. “Why has this happened? Because the hypothesis that that experiment tested out was generated based on prior data from experiments on only males. So, of course, it only worked in males."

The bias in research can have lasting effects on pain treatment and may help explain why some analgesic medications are more effective when taken by men.

"This research suggests that lots of what's in the pipeline right now, if it works in anyone at all, will largely be men. Whereas the clear majority of chronic pain patients have been and continue to be women," Mogil said.

Steps have been taken to reduce bias in pain research. If they want to get government funding, researchers in the United States, Canada and several European countries are now required to evaluate both sexes in their research. Mogil is optimistic those policies will eventually make a difference, but it may take awhile to undo decades of research that focused primarily on male animals.

“Performing biomedical experiments in both sexes is not only the ethically correct thing to do but also the scientifically correct thing to do, especially if we wish to reverse the particularly unimpressive track record of clinical trial success in the past few decades,” Mogil wrote.