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“Women complain more about pain.” “Men are more stoic, so that when they do complain of pain, it’s real.” These are the kind of gender stereotypes that may be interfering with an observer’s ability to accurately assess someone’s level of pain and treat them appropriately, according to new research.

Specifically, the research suggests that women in pain are at risk of being undertreated, study co-author Elizabeth Losin, PhD, Assistant Professor of Psychology and Director of the Social and Cultural Neuroscience Lab at the University of Miami, said in a release.

The research, which was published in The Journal of Pain, consisted of two studies. In one, 50 people were asked to watch video clips of men and women who were being treated for shoulder pain and had filled out self-reports about their current level of pain. The camera focused on the patients’ facial expressions while they did range-of-motion exercises. Study participants (deemed “perceivers”) were asked to estimate the patients’ pain in on a scale of 0 (absolutely no pain) to 100 (worst pain possible).

In the second study, 200 perceivers — 100 of whom had chronic pain issues like arthritis or back pain — watched similar video clips of male and female shoulder pain patients. The perceivers were asked to estimate patients’ pain, as well as make a recommendation for treatment. For the latter, they chose between pain medications or psychotherapy for treatment and then, based on their choice, prescribed either a dose of pain medication or a number of psychotherapy sessions.

According to findings from both experiments, the perceivers consistently estimated that women were in less pain compared to the pain that the men were experiencing—even when both genders’ self-reports indicated the same level of pain.

“Female patients were perceived to be in less pain than male patients at the same level of pain expressiveness and pain self-report,” the authors wrote.

When the perceivers were asked to make treatment recommendations for each shoulder pain patient, they generally suggested medication. However, they were more inclined to suggest psychotherapy for female patients and they often recommended higher amounts of pain medication for the males.

Perceivers also completed the Gender Role Expectations of Pain measure (GERP) questionnaire to provide insights into any underlying gender biases regarding pain. Questions included what is the typical woman’s sensitivity to pain; what is the typical man’s sensitivity to pain; what is your sensitivity to pain. Researchers found that these biases did in fact impact perceivers’ recommendations for the shoulder pain patients. Many perceivers had indicated that women (in general) are more likely than men to report that they’re in pain, but they interpreted this as meaning that women are more apt to exaggerate their discomfort.

“Importantly, these biases were observed while participants viewed actual patients in genuine clinical pain, and when controlling for pain facial expressiveness and patients’ self-reported pain,” the researchers wrote. “These findings suggest that women’s pain is underestimated compared to men’s and perceived to benefit more from psychotherapy.”

That might be a problem in real-life settings, because it suggests that health care providers might similarly underestimate (and therefore undertreat) pain in women, says study co-author Tor D. Wager, PhD, a Professor of Neuroscience at Dartmouth College.

“Gender bias in pain care exists, and may undermine the appropriate provision of support by family and community members, and of care to those suffering,” says Dr. Wager. “Recognizing this is a first step towards counteracting it — psychological research shows that awareness of bias can reduce or eliminate it in some cases.”

In short, women in pain are at risk of being undertreated, and more of an effort needs to be made to eliminate gender bias in health care settings.

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Research identifies gender bias in estimation of patients’ pain. University of Miami News. April 6, 2021. https://news.miami.edu/stories/2021/04/research-identifies-gender-bias-in-estimation-of-patients-pain.html

Zhang L, et al. Gender Biases in Estimation of Others’ Pain. The Journal of Pain. March 5, 2021. doi: https://doi.org/10.1016/j.jpain.2021.03.001.