Hysterical, Emotional, Exaggerating: Women, Bias and Undertreatment of Pain

"There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their pain."
Hoffmann & Tarzian (2001:13)



Value systems of a culture have an impact on pain perception from the very beginning. Children are socialised how to react to pain, i.e., boys are often discouraged from expressing pain. And when they are adults, they show the same communication patterns. In a study, male pain research participants reported that they "felt an obligation to display stoicism in response to pain". Impression management also seems to play a role since men report less pain in front of a female researcher than a male researcher. Men and women also show differences in how they report their pain to health-care providers. Interestingly, although women are better at describing their pain sensations, they receive less pain medication.

Miaskowski reported on several studies that identified such differences in response and treatment. Faherty and Grier studied the administration of pain medication after abdominal surgery and found that, controlling for patient weight, physicians prescribed less pain medication for women aged 55 or older than for men in the same age group, and that nurses gave less pain medication to women aged 25 to 54.
Calderone found that male patients undergoing a coronary artery bypass graft received narcotics more often than female patients, although the female patients received sedative agents more often, suggesting that female patients were more often perceived as anxious rather than in pain. Another study, examining post-operative pain in children, found that significantly more codeine was given to boys than girls and that girls were more likely to be given acetaminophen.'
Miaskowski further reported on two more recent studies. In a 1994 study of 1,308 outpatients with metastatic cancer, Cleeland and colleagues found that ofthe 42 percent who were not adequately treated for their pain, women were significandy more likely than men to be undertreated (an odds ratio of 1:5). In another study of 366 AIDS patients, Breitbart and colleagues found that women were significantly more likely than men to receive inadequate analgesic therapy. (...)
A recent prospective study of patients with chest pain found that women were less likely than men to be admitted to the hospital. Of those hospitalized, women were just as likely to receive a stress test as men, but of those not hospitalized, women were less likely to have received a stress test at a one month follow-up appointment. The authors attributed the differences in treatment to the "Yentl Syndrome," i.e., women are more likely to be treated less aggressively in their initial encounters with the health-care system until they "prove that they are as sick as male patients." Once they are perceived to be as ill as similarly situated males, they are likely to be treated similarly. (...)

Hoffmann and Tarzian (2001) come to the conclusion that women are taken less seriously when they report pain and seek help. One likely explanation for the gender-specific difference in treatment is the health-care provider's attitude ... and bias. According to several studies, women are also perceived as being able to tolerate more pain than men, as having a "natural capacity to endure pain".

McCaffery and Ferrell explained this seeming contradiction by speculating that while society attributes strength and bravery to men, these characteristics are displayed by an unwillingness to complain or express discomfort rather than by an actual tolerance of discomfort.

Health-care providers tend to doubt the pain experience of women. A great many women feel that their doctor did not take their pain seriously and expected them to put up with it. The image of the hysterical and emotional woman may also be one reason why female chronic pain patients are more likely to be diagnosed with histrionic disorder.

- - - - - - - - - -
- Hoffmann, D. E. and Tarzian, A. J. (2001). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. Journal of Law, Medicine & Ethics, 29, 13-27.
- photographs by Sepp Werkmeister via