International Women’s Day and Pain

Key Points

1. Millions of women around the world living with pain but remain untreated.

2. There are multiple factors why women experience more pain, through the biological, psychological and social reasons.

3. Women have higher prevalence in fibromyalgia, musculoskeletal pain, headache, visceral abdominal and pelvic pain.

4. Healthcare providers need to acknowledge and understand the different needs between gender and provide tailored cares.

Every day millions of women around the world suffer from chronic pain but many remain untreated. 

A systematic review in 2018 by Anke Samulowitz was titled “Brave men” and “Emotional women”, confirming that doctors’ perceptions of and interactions with patients were different dependent on their gender. Men living with pain were deemed to be “masculine breadwinner striving to continue to live normal lives” while women living with pain were “sensitive hysterical women had to learn to prioritise duties and set limits”. The construct of gendered norms can lead to unconscious bias on clinical decisions. 

How does gender play a role in Pain?

There are multiple factors why gender might play a role in pain perception, through the differences in biological, psychological and social differences. These could range from genetic composition, social status, exercise capacity and information processing in the brain. 

One of the important factors is the interplay on hormonal changes with puberty and the initiation of menstrual cycle and its role in reproductive status. Oestrogen has been proven to increase the nociception and pain, through its action on several cellular changes in the central nervous system. With the changes in puberty and menstrual cycle, the intermittent inflammation pathways could promote the development of peripheral and central sensitisation, which increase the responsiveness to the normal input. 

Pain is also complicated by issues of family stress, body issues and sexuality. The psychological differences, coping mechanism and strategies, social conditioning and expectation might explain the perception on pain severity and how it impacts on activities of daily living. 

Pain Conditions with higher prevalence among women living with pain

1. Primary pain syndrome – including widespread pain, fibromyalgia, osteoarthritis, rheumatoid arthritis

2. Musculoskeletal pain – as women age, they experience more compression fractures, vertebral changes, scoliosis, loss of bone mass with higher risk of fracture

3. Visceral abdominal pain – higher prevalence with 3:1 female:male ratio with the diagnosis of irritable bowel syndrome

4. Headache – migraine prevalence is 18% in women, compared to 7% in men. Most common between ages of 20-45 years old. Women reported more painful and longer lasting headaches with associated symptoms, such as nausea and vomiting

5. Visceral pelvic pain – there is significant potential history of intimate partner violence, with high proportion of women suffering chronic pelvic pain in the absence of physical injury, childbirth or identifiable procedural causes. Some specific diseases are evident among women, such as dysmenorrhea, vulvodynia and endometriosis.

International Women’s Day

As 8 March is the International Women’s Day, it is important to raise awareness that pain is not a symptom of an “emotional woman”, but managing chronic pain takes a good partnership between doctors and patients. We need to recognise the different health needs between men and women. Let’s call out gender bias and inequality. We can help create an inclusive world.

I would also like to acknowledge and celebrate the great achievement of current ANZCA president, Dr Vanessa Beavis, for her contribution in leading the college through COVID-19 pandemic and advocating for our college to adopt Te Reo Māori – Te Whare Tohu o Te Hau Whakaora – at the Cultural Safety and Leadership Hui in Waitangi on 28 February 2021.

#ChooseToChallenge #IWD2021 #ANZCA #TeReo 

Reference

1. Samulowitz, Anke et al. “”Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain.” Pain research & management vol. 2018 6358624. 25 Feb. 2018.

2. Here’s Why Women Are More Likely to Have Chronic Pain. Cleveland Clinic. https://health.clevelandclinic.org/women-are-more-likely-to-have-chronic-pain-heres-why/amp/ Accessed on 7 March 2021

3. Sharpe L. Why some doctors don’t take women’s pain seriously. ABC News. https://amp.abc.net.au/article/10945368 Accessed on 7 March 2021

4. Laura Kiesel. Women and pain: Disparities in experience and treatment. Harvard Health Publishing. https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 Accessed on 6 March 2021

5. Real Women, Real Pain. Fact sheets. International Association for the Study of Pain. https://www.iasp-pain.org/Advocacy/Content.aspx?ItemNumber=1107 Accessed on 7 March 2021

6. College adopts Te Reo Māori name. ANZCA. https://www.anzca.edu.au/news/nz-news/college-adopts-te-reo-maori-name Accessed on 7 March 2021