Women, Bias, Discrimination, and Chronic Pain

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Centuries after women were blamed for their own pain, called “hysterical” because they hurt, we find the cultural influence regarding women’s pain hasn’t changed much. Our pain remains misunderstood and mistreated. The disparity section of the National Pain Strategy tells us bias, stigma, and discrimination exists and women exhibiting pain from chronic fatigue syndrome, fibromyalgia, and other conditions are among the vulnerable.

Women in pain, risks, hysteria, and the wandering womb

The Institute of Medicine (IOM) report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, says 60 percent of women experiencing their first childbirth rate pain as severe; 18 percent of women who have caesarean deliveries and 10 percent who have vaginal deliveries report persistent pain at one year. They also found five percent of American women aged 18 to 65 experience a headache 15 or more days per month over the course of one year. Despite knowing women are at greater risk for developing persistent pain and that women do experience pain differently, women were found to be disproportionately undertreated for pain.

Susan Evans, M.B.B.S., F.R.A.N.Z.C.O.G., gynecologist, pain medicine physician, and laparoscopic surgeon, gave a historical account of women and pain in an article she wrote in 2015 for The Conversation, an academic journalistic website supported by the University of Adelaide. She tells us, “ancient Greek physicians came up with a novel explanation: the ‘wandering womb.” The womb was believed to move upward in a woman’s body whenever it became hot and dry, searching for cool moist places, and causing stress and damage to her physical and mental well-being.” And she relates, “Hippocrates (460-370 BC) used the term ‘hysteria,’ derived from the Greek word ‘hysteros’ for ‘womb,’ to describe a wide variety of female emotional and physical conditions, inferring women in pain are weak, inferior or irrational.”

In 2011, the IOM report mentioned above tells us not much has changed.

The impact of skepticism

A 2003 review, It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors, found “women with medically unexplained disorders have reported negative experiences during medical encounters. Accounts of skepticism and lack of comprehension, feeling rejected, ignored, and belittled, blamed for their condition and assigned psychological explanation models are common.”

They found women do not want to appear “too strong or too weak, too healthy or too sick, or too smart or too disarranged and struggle for the maintenance of self-esteem or dignity as patients and as women.”

As a female who lives with chronic pain from multiple well-documented sources, I have felt this pain too. We must change the way our pain is perceived, judged, and treated, so our complaints are taken seriously, and we receive the care we deserve.

Hope

Women with diseases that cause chronic pain are more likely to be wrongly diagnosed, and possibly told to take an antidepressant or even go home and rest until it passes. If that happens, it is unfair and could be dangerous. The right health care provider will know women experience chronic pain differently and women’s health risks for chronic pain are significantly different for a variety of reasons.

Harvard University’s Nurses’ Health Study and Nurses’ Health Study II are among the largest and longest running investigations regarding risk factors for major chronic diseases in women, many of which can cause persistent pain. I have participated in this study for over three decades. When they started the study, they felt nurses would be more likely to stay the course — and we have. The study is now in phase III, and they are recruiting the next generation so we can continue to move forward in understanding women’s health. So, please encourage your nurse friends or acquaintances to join us in this quest.

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