Disparities In Gender Of Pain Management Leave Some Struggling

Women are more likely than men to experience chronic pain, however emerging research into the gender of pain management shows that females are less likely to receive medications and may suffer more as a result. And the medications they do receive sometimes cause more harm than good.

Women are, on average, smaller than men and have a higher percentage of body fat, which means their bodies metabolize drugs differently. Although researchers believe some gender discrimination may be at play, biological disparities sometimes can and should influence how doctors prescribe drugs, scientists say.

Part of the problem is that women are underrepresented in medical research and so researchers aren’t clear of the differences among genders when drugs come onto the market. However, the medical community is increasingly aware of the issue and federal guidelines are beginning to change.

One change happened in 2013, when the Food and Drug Administration (FDA) recommended cutting doses of the popular sleep drug Ambien for women because they remained drowsier for longer periods of time than men, reports The New York Times. Women take longer to metabolize the drug, and the disparity in biochemistry affects other drugs, too.

Women and men process drugs differently, which means doses should vary by gender, researchers say.

For example, men and women react differently to anesthesia. However, in this case, women need more than men. This complicates the gender of pain management issue because women do not automatically need smaller dosages of every drug; it depends on the type of drug, according to The New York Times.

Because chronic pain affects 100 million people in the U.S., a large number of them women, the issue is critically important. And unfortunately, women’s concerns of pain are often overlooked, according to a research review conducted by the American Society of Anesthesiologists.

ASA Dr. Donna-Ann Thomas says:

“I can’t tell you the number of women I see who have been told they just have to live with the pain…It’s just heart breaking because many of these women have been suffering a long time. Women, especially older women are less likely to speak up and seek treatment for their pain.”

Researchers say the types of pain women needlessly suffer from include back pain and pain resulting from breast cancer surgery, which ASA says sometimes compares to phantom limb pain resulting from an amputation.

Doctors are often unaware of the different ways men and women experience pain, but the gender of pain management is a hot area of research.

ASA’s review of studies revealed that while women sometimes receive opioids, the drugs are frequently prescribed incorrectly and end up causing more harm than good. Proper use of anesthesia is also critically important during breast cancer surgery and can impact how well a woman recovers.

Some of the optimal ways of using anesthesia are not commonly used today. For example, ASA’s review showed the best anesthesia for breast cancer surgery is actually regional numbing combined with a nerve block injection, and not general anesthesia.

For other types of pain conditions, doctors are not aware of the array of effective alternatives to painkillers, researchers say. For example, music has been found to ease labor pains, yoga has been found to be a helpful tool in the fight against back pain, and rose oil reportedly helps relieve menstrual pain.

Researchers emphasized the importance of visiting a doctor who specializes in pain treatments since general practitioners may not have knowledge of alternative methods.

The potential damage from misusing pain medications is becoming more apparent every day. The ASA review found one in seven pregnant women are prescribed opioids for pain, a practice that may harm the unborn baby. Another ASA study revealed that opioid use has caused a growing addiction problem among pregnant women.

The number of opioid-dependent pregnant women has skyrocketed 127% in the last 14 years, leading to an increase in rates for maternal death and stillbirths.

Women taking opioids while pregnant were also more likely to deliver by cesarean and stay in the hospital longer, according to ASA. Study author Dr. Lisa Leffert says:

“Our study shows that these patients are at very high risk for developing complications. Given the rapid rise in opioid abuse and dependence in these patients, there is an urgent need to understand the link with bad outcomes and to develop interventions to prevent them.”

Women in pain are also more likely than men to be diagnosed with mental illness.

Beyond medicinal disparities in the gender of pain management, there’s a significant psychological component. Doctors are more likely to dismiss pain reported by females as having an emotional source, reports The New York Times. Because doctors are less likely to take women’s reports seriously, women are less likely to receive appropriate pain treatment.

And while women’s pain may continue unabated, they may receive wrongful primary diagnoses such as depression, which, the Times reports, could lead to treatment for mental health conditions that don’t exist.

Conditions like fibromyalgia are a good example of the tendency among medical professionals to dismiss women’s complaints of pain. Although awareness about fibromyalgia has grown, for a long time women reporting the condition’s vague symptoms were thought to be making them up.

As late as 2008, when the first drug for fibromyalgia appeared on the market, some doctors said they didn’t believe the disease existed, reports the The New York Times. The article says:

“(Some doctors say) diagnosing the condition actually worsens suffering by causing patients to obsess over aches that other people simply tolerate.”

Fast forward about seven years, and now doctors may assign the fibromyalgia label to anyone experiencing pain that doesn’t fit into simple diagnostic criteria, writes pain advocate and author Laurie Edwards.

Edwards suffered from strange symptoms throughout her life, which she says were often dismissed by doctors as the result of anxiety and other emotions. Then at 23, Edwards was diagnosed with a rare lung disorder. Finally, her lifelong troubles were vindicated by a diagnosis.

But many other women continue to fall outside the neat confines of a diagnosis, leaving them searching for answers in a medical system that often fails them, Edwards says.

What are your experiences about disparities in the gender of pain management?

Image by Pedro Ribeiro Simoes via Flickr

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