King's College London

In a study of thousands of hospital patients, researchers found that not only were healthcare providers less likely to prescribe women with pain relief medication than men, they were also less likely to record their pain score and kept women in emergency departments for longer.

Researchers believe misconceptions around the ability of women to tolerate pain, as well as beliefs around pain exaggeration, are behind the disparity, which could be causing unnecessary suffering among women.

The researchers said: “Our work reveals a systematic sex-related disparity in pain management: a female patient discharged from the emergency department is significantly less likely to receive treatment for a pain complaint, compared to a male patient.

“Datasets from emergency departments revealed that female patients were less likely to receive a prescription for any type of analgesic medication, both opioids and nonopioids, compared to male patients.

“Female patients were less likely to receive analgesics for every pain score and at every age group, even when controlling for multiple patient and emergency department characteristics.

“Females also received fewer analgesics from both male and female physicians. Their pain score was less likely to be recorded by triage nurses, and they stayed longer in the emergency department.”

The findings were revealed in a new study, Sex bias in pain management decisions, co-authored by Moses Shayo (King’s College London), Mika Guzikevits (Hebrew University of Jerusalem), Tom Gordon-Hecker (Ben-Gurion University of the Negev), David Rekhtman (Hadassah Medical Centre), Shaden Salameh (Hadassah Medical Centre), Salomon Israel (Hebrew University of Jerusalem), David Gozal (University of Missouri), Anat Perry (Hebrew University of Jerusalem), Alex Gileles-Hillel (Hadassah Medical Centre), and Shoham Choshen-Hillel (Hebrew University of Jerusalem).

Data for the study was drawn from the hospital discharge notes of more than 21,000 people with pain complaints in the US and Israeli healthcare systems.

Data from Israel showed that a patient’s likelihood of receiving a pain-relief prescription was lower for women (38 per cent) than men (47 per cent). The finding was supported by similar data from the US, with women (26 per cent) less likely to receive pain relief prescriptions than men (31 per cent).

The researchers believe that pre-existing biases held about men and women and perceptions of pain may explain the disparity seen in their results.

They said: “Previous work has shown that individuals tend to perceive females’ pain as less intense than that of males. This perception bias has in turn been explained by a gender–pain exaggeration bias: People view females as more emotional and assume that they overreport their experienced pain compared to males.

“The literature has suggested additional stereotypes that may also explain why female patients receive less pain treatment, such as the perception of females as more capable of physically tolerating pain than males.

“While other stereotypes may be at play, our findings of bias in healthcare providers’ pain perception are in line with the exaggeration mechanism.”