Today is International Women's Day - Let's Break the Bias in Pain Management
Unfortunately bias exists in all areas of medicine, including pain management.
This years theme for International Women's Day is #breakthebias. For Women there are two biases when it comes to pain management - sex/gender (women), and ethnicity.
When being treated for pain, women are more likely to be given a prescription for a sedative than a painkiller. This is due to an incorrect assumption that women are more likely to visit an emergency room than a man. Unfortunately, this can have undesirable, and sometimes fatal repercussions. A prime example of this is a heart attack (MI). Women are 7x more likely to be misdiagnosed and sent home than a man.
Often, a woman may exhibit different signs and/or symptoms than a man. For example, a woman experiencing a heart attack may experience pain in her upper back/shoulders, shortness or breath, or heartburn. They may or may not experience the 'classic' signs of a heart attack that we all know (chest pain, pain radiating down left arm etc.).
Despite women making up 70% of the population experiencing chronic pain, 80% of the studies have been performed on male mice or male men. Because of this, some research institutions are now requiring that all research be performed on members of both sexes. In this case we are strictly discussing sex - male or female as assigned by your DNA.
Trans women, non-binary females, and other individuals in the LGTBQ2S+ community experience their own biases in the world of chronic pain. Some studies have shown that women in this community are at a higher risk of developing chronic pain. There is also increased bias in the healthcare system regarding members of this community. A large portion of this comes from the lack of understanding regarding the needs of this community. For example certain medical cutoffs are gender based - ie a female qualifies for a treatment at a lower level than a man. However, a trans-woman may be listed as male on their medical records, and therefore not qualify. In addition, there are higher rates of depression in the LGTBQ2S+ community. It has long been established that there is a higher risk of developing chronic pain in individuals that are depressed, and that there are higher rates of depression in those with chronic pain. It's a vicious circle.
"Black people's skin is thicker than white people's skin"
" Nerve endings are less sensitive in people of colour"
These are two examples of unfortunate medical misconceptions that still exist in a portion of the medical field.
These examples, while completely and utterly ridiculous result in increased bias in the medical treatment of pain for women of colour. One study suggested that individual's of colour were 20% less likely to receive pain medication. This study includes both men and women of colour, therefore women of colour face two biases, being a woman, and having darker skin.
These are all biases that EVERY medical practitioner needs to identify and change in their practices.
In my practice women are treated as individuals, regardless of gender identity, sexuality, race, ethnicity, or any other defining factor that makes you you.