Women in Chronic Pain & the Gender Bias

In January of 2007, I was 37 weeks pregnant with my second child. I slipped and fell, clumsily, wearing my slippers on our carpeted master bedroom floor. With the added weight of the baby, I fell hard on my right side, and the pain radiating from my foot and ankle caused me to scream and scare my then toddler son. My husband rushed home from work, and took my son and me to the nearest primary care facility. The clinical staff seemed genuinely sorry for me, as the only thing they could prescribe was Tylenol and Tiger Balm, and strapped me into a soft walking cast, which I wore until I delivered three weeks later.

Not long after my daughter was born, the pain in my foot and ankle had returned and intensified. I started seeing a local podiatrist, who after a few months of treatment, X-rays, and MRIs, told me the shocking news: It wasn’t my foot that was causing the pain; it was in fact my back. I was referred to a local physiatrist, who ordered additional tests, and deemed that I had sacroillitis. He explained that when I had fallen, my body was full of the hormone Relaxin, which is produced by the ovary and placenta that prepares the body for child birth, allowing for limbs, joints, and pelvis to relax and widen the cervix. When my body hit the floor, my pelvis shifted, and after childbirth, it became permanently dislocated. My doctor said it was like strategically gluing one piece of paper atop another, but while the glue is still wet, physically shifting the two out of place.

During the next five years, I tried every recommended medical procedure, along with various cocktails of medications. I sought acupuncture, trigger point needling, trigger point injections, massage, chiropractic adjustments, radio frequency ablations, and physical therapy. I collected a closetful of medical equipment, but nothing relieved the incessant pain, that had now spread from my lower back to both hips, legs, and feet.

It wasn’t until 2013 when I began seeing yet another new physician who discovered something in my MRI that none of the other doctors had noticed: a tiny piece of bone fragment sticking out of and piercing a hole into my sciatic nerve, with a tear in the L5/ S1 disc above, which was leaking fluid onto the punctured nerve below. Unfortunately, it had been too late. As she attempted a methodical, sniper-style steroid injection, my L5/S1 disc burst. I was placed in a wheelchair, packed with ice, while the doctor called her surgical colleague on his personal cell phone to schedule an immediate discectomy/laminectomy. The surgery and arduous physical therapy that followed provided only temporary relief, as the disc became reherniated, and a follow-up electromyogram with the neurologist determined I had permanent sciatic nerve damage.

One constant that remained during all my years in pain management was how I was treated by certain doctors, particularly before the discovery of the bone fragment in my sciatic nerve. At one point, a pain management physician referred to me as “an addict”, another “a bored housewife”. One doctor told me that the pain was manifested by my personality, and had the audacity to tell me I sought pain medication because I couldn’t handle my son’s autism. One doctor even refused me as a patient, assuming I was a drug seeker. After a few years of attending appointments alone, I finally asked my husband to accompany me. I felt humiliated, depressed, angry and frustrated, while physically pained and exhausted.

Immediately, I noticed a different tone and attitude from these same doctors when my husband sat in the exam room. Many would describe my husband as a soft spoken, measured and kindnatured man. He mostly listened when the doctors would review the pain chart I filled out each month, and the list of currently prescribed medications. He did, however, contribute his side of things, as my partner and our children’s father. He made sure the doctor understood that we both struggled with my pain. He would remind the doctor I was doing the best I could, but the pain took a toll on me. Having him in the exam room helped me feel safe and protected, which in turn lessened my anxiety.

An October 2015 article in The Atlantic, titled “How Doctors Take Women’s Pain Less Seriously”, gained a lot of traction in both the main stream media and medical community. The op-ed essayist, Joe Fassler, recounted the time his wife Rachel was struck by mysterious, debilitating symptoms one random Wednesday morning. Their trip to the ER revealed Rachel’s terrifying, life threatening experience, and the “sexist, condescending treatment” she endured.

In 2013, author, Northwestern University professor, and chronic pain survivor, Laurie Edwards, wrote a piece for the New York Times titled, “The Gender Gap in Pain”, concluding “pain conditions are a particularly good example of interplay between sex (our biological and chromosomal differences) and gender (the cultural roles and expectations attributed to a person). Women have hormonal cycles, smaller organs, higher body fat composition – all of which are thought to play a role in how drugs affect our bodies. We also have basic differences in gene expression, which can make differences in the way we metabolize drugs.”

According to a groundbreaking 2014 study, conducted by the National Pain Report, a survey of over 2,400 women concluded that an overwhelming 90% of chronic pain patients feel the healthcare system discriminates against female patients. Nearly 60% of the women surveyed said they had fibromyalgia, making it the most common condition reported. Back pain was a close second (59.6%), followed by migraine (34%), osteoarthritis (34%), and neuropathy (27%). The study also concluded:

Medical researchers worldwide continue to study the differences between men’s and women’s health to tighten the gender gap in treatment. If you or someone you know suffers from chronic pain, there are steps you can take to ensure you’re receiving the best possible care:

  • Express your concerns to the doctor, and keep a diary or log of your pain to bring to each visit.
  • Ask your husband, partner, family member or friend to attend each visit. A second perspective from someone who knows you well can be helpful, and because sometimes results can be overwhelming, can help take notes or ask additional questions that might not occur to you.
  • Change doctors. If you feel you’re not receiving the proper care, receive a recommendation from your general practitioner or someone you trust.
  • Educate yourself about your condition. You are your own advocate. Learn what diet, exercise, stress relieving activities you can do to live and sleep better.
  • Be kind to yourself, and learn to say “no”. The everyday stress of juggling a career, children, marriage, and relationships is challenging. Chronic pain can physically and psychologically make life seem impossible at times.
  • Join a pain advocacy support group like the american pain foundation. If you believe you’re being treated unreasonably, you can speak with an advocate who can offer help and perspective. Additionally, an advocate can look into your current treatment with your physician, and file a formal complaint if they deem appropriate.