Anatomical differences, age, pain response, cultural bias, and a lack of overall emphasis on pain treatment are at root.
The diagnosis and treatment of pain in America has been a hot topic since a 2012 Institute of Medicine (IOM) report that broke new ground.
The CliffsNotes version of how we’re doing: not very well. The report said about 110 million Americans have chronic pain, yet diagnosis and treatment is overlooked and disjointed. That applies to men and women alike.
Research has lagged behind, leaving doctors with little to go on but their own instincts based on your subjective report of pain. As a result, cases of delayed, missed, and incorrect diagnoses are common, in the range of 10 to 20 percent, a study found.
“Pain is a highly complex phenomenon that involves biological, psychological and social variables,” a review on the cultural aspects of pain management reported.
A federal survey found that women “experience” pain more than men. “Women were more likely to experience pain (in the form of migraines, neck pain, lower back pain or face and jaw pain) then men. Women were about twice as likely to experience migraines or severe headaches, or pain in the face or jaw as men.”
In another study that has become the cornerstone on women’s pain, the authors concluded that men and women appear to “experience and respond to pain” differently.
That study, The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, went on to acknowledge that it’s difficult to know whether the difference has biological or “psychosocial” origins.
Three aspects of male and female biology “plainly differ,” the authors said. Those include the pelvic reproductive organs, types of circulating hormones, and cyclical changes in hormone levels.
There also may be a link between reproductive hormones and inflammation and pain. Specifically, the hormones may “act directly in the muscles to modulate the release of nitric oxide,” which causes blood vessel dilation, inflammation, and pain.
Research has also found differences in the brain and central nervous system of men and women that may be part of differences in pain response.
“Underlying biological differences in pain mechanisms may predispose women to have more pain, and may affect recovery from pain, but (cultural) psychological factors also influence pain perception and behavior,” the study authors noted.
The study also found that women are more likely to have their pain characterized as “emotional” and “psychogenic.”
Together, all those factors can contribute to misdiagnosis, the paper claimed.
A report by the Campaign to End Chronic Pain in Women (CECPW) found that misdiagnosis of six conditions that affect women either exclusively or predominantly —- chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, temporomandibular disorders, and vulvodynia —– adds as much as $80 billion a year to America’s healthcare costs.
The medical community has acknowledged the need for better pain control, with an associated concern over narcotic abuse, prescriptions, and related deaths.
One result has been an increase in pain specialists and pain clinics in the U.S. There are 3,000 to 4,000 such specialists who take take an integrated, multifaceted approach to diagnosing and treating pain individually —- through a correlation of condition severity and patient reports. You can find one in your area through the American Academy of Pain Medicine.
“A (multidisciplinary pain management program) offers a variety of skills taught by trained staff to help a person better manage his or her pain,” says the American Chronic Pain Association (ACPA).
“These programs may not offer a cure, but they can help to improve the quality of life and at the same time reduce the overwhelming control that pain can have (over) daily life.”
Although advocates such as the Campaign to End Chronic Pain in Women has have been critical of diagnoses that characterize women’s pain as psychological, pain specialists say there is indeed a psychological component to pain. Cognitive therapy that teaches pain coping, self-management skills can be helpful for many people with chronic conditions.
As is the case for many situations related and unrelated to medicine and pain, true communication is a key that is often lacking. Patients need to be willing to speak to their doctors in plain, even blunt, language.
Women in particular need to be comfortable expressing concerns over diagnosis and treatment they believe is based on their gender. Doctors need to be good listeners and be willing to allow the time each patient needs.
Never be the passive recipient of any diagnosis or treatment for pain or any other conditions. You are a partner in your health maintenance. Arm yourself with self-education.
If you have experienced chronic pain, you may feel as though you may never find your way out. But you can find help.
Reach out to the ACPA. It provides advocacy, comprehensive information on a range of chronic pain, and access to support groups. It will help you navigate what it refers to as the “maze of pain.” If you have experienced chronic pain, you may feel as though you may never find your way out.
February 28, 2020
Christopher Nystuen, MD, MBA