A Pained Life: Myths about Women

A Pained Life: Myths about Women

I was asked to write a column on how women may be treated differently than men when they complain of chronic pain.

The National Pain Report is conducting a survey of women in pain and I am eager to see the results.

Decades’ old research found a gender bias against women. We are much more likely than men to have higher levels of chronic pain and chronic pain disorders. I hoped this prejudice had changed, so I decided to research the issue anew.

Sadly, I found the apparent medical stereotype still held.

In a Google search for “women and chronic pain and abuse,” I found tons of articles. In a similar search for “men and chronic pain and abuse,” I found almost none.

A number of the articles stated there was a connection between developing chronic pain and some form of trauma in one’s past.

What we often don’t read is, as one researcher wrote, “Many people with chronic pain have no history of trauma in their background. So, trauma doesn’t typically cause chronic pain in a direct way. Nonetheless, the high rate of trauma in people with chronic pain suggests that it might have some relationship to the development of chronic pain.”

doctor with patientAs long as the research tends to focus on women, the perception that we have higher incidences of chronic pain and trauma continues to flourish.

Too often women report doctors and other healthcare practitioners – who are often not familiar enough with chronic pain — assume psychological or psychiatric distress as the root cause of all their patients’ symptoms and pain.

And too often I see counseling suggested as a major component in overcoming a physical chronic pain disorder.

It has been postulated that abuse changes the nervous system. It makes it more sensitive to pain and developing pain disorders. If true, that is not an issue of psychiatry or psychology but of physical, potentially neurological, changes. They are real and physical — and need to be treated in a real and physical way.

Counseling can certainly help.

I have seen it work with people with disorders of chronic pain but also other illnesses, such as cancer. We bring our psyches into the exam room. They stay with us as we deal with pain and disease. Having someone who understands, accepts you, accepts your pain and your disease, lets you be “you” without insisting you change, can only be of benefit. This might be even truer for those with chronic pain, given that too many of us hear from friends, colleagues, family, and even the medical profession: “I don’t believe you.”

Trigeminal neuralgia is known as “the suicide disease” and “the worst pain known to man.”

My pain was so great; especially the pain triggered by even the slightest touch to the affected area, that I had my face washed under general anesthesia because I could not wash it. As a result, I would have inches of dirt buildup on my forehead and scalp. Nevertheless I still had a doctor say to me, “Your pain can’t be as bad as you say it is.”

It is hard sometimes to know if the reaction from a doctor is solely because we are women.

I walked into a doctor’s consulting room and the air conditioning was on. It immediately triggered my pain. Hesitantly I asked, “Could you please turn that off? It is really increasing my pain.”

The doctor looked at me disbelievingly and said, “If it was that bad you would have turned it off yourself.”

I felt he would not have said that to a man. Was I right? Or was I being too sensitive?

A man might have turned it off himself. Women have the social constraints that gender stereotypes require. We are usually taught to be courteous and not take action without permission.

The stereotype also goes to how we present ourselves physically. We need to look good, to have our clothes nice and matching and looking pretty, our hair and makeup in place. Makeup camouflages our real coloring, often a lot paler because of our level of pain. Styling hair and looking our best can be a major effort because of the pain.

The doctor usually doesn’t ask, “How long did it take you to get dressed, do your hair? What does that do to your pain?”

Instead, I have heard and other women tell me they’ve heard, “You must be feeling better. You look very nice today.”

The inverse also happens. You come in looking a little disheveled, hair not done up, the easiest of clothes to wear, shirt tail out, etc. Does the doctor ask, “You look out of sorts today. Is that because of the pain?”

Rarely, if ever, is that said. Instead the patient is asked “Are you depressed? Because you look out of sorts today.”

Stereotypes and research continue to stigmatize women in pain. Way too often the psychological is put first and our complaints of physical illness put in the background. Studies have shown this is true even when women complain of heart attack symptoms — yet women are often sent home while the men are hospitalized.

As long as the research continues to discriminate, by looking much more often at only women, the stereotypes and the mistreatment will continue.

It is bad enough and hard enough that we have to put up a fight against the pain. Unfortunately, the myth of women in pain and a psychological basis is another fight we continue to endure.

Carol Levy

Carol Levy

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol was accredited to the United Nations Convention on the Rights of Persons with Disabilities, where she helped get chronic pain recognized as a disease.

Carol is the founder of the Facebook support group “Women in Pain Awareness”. Her blog “The Pained Life” can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Authored by: Carol Levy, Columnist

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Myron Shank, M.D., Ph.D.

As a physician, myself, I wholeheartedly agree that there are serious problems with most physicians’ perceptions of chronic pain. However, I take issue with you about the reasons. I, too, am highly critical of physicians who see “psychological or psychiatric distress as the root cause of all their patients’ symptoms and pain.” Most of the studies that purport to show such causal connection are of such poor quality as to deserve the title, “junk science.” I have often been amused that those who have (at best) a superficial knowledge of psychiatry and psychology frequently believe that physical symptoms are due to often psychosomatic conditions, but those I with whom I have been acquainted who were actually qualified to make such diagnoses believe that psychiatric and psychological conditions rarely, if ever, are the causes of physical symptoms. On the other hand, the preponderance of female subjects in research about abuse and with chronic pain is due not to bigotry against women, but to the almost total denial of the problems of abuse of men–with or without chronic pain. The stereotype that women are the abused and men are the abusers is partially true, but the fact that men are often victims of abuse (or that women are often perpetrators of abuse) is almost completely ignored. Having expressed my own strong biases against psychological and psychiatric factors as causes of pain, I fully recognize that some drugs developed to affect neurotransmitters and their receptors in psychiatric diseases may be useful for their effects on neurotransmitters and their receptors in chronic pain. Likewise, I believe that counseling may be useful in coping with chronic pain–or any other refractory chronic illness–but neither the physician nor the patient should confuse this with treatment of the pain, itself. Likewise, I believe that you have misinterpreted the physician who told you that, if your pain was that bad, you would have turned turned the air conditioner off, yourself. As a man, I would never consider turning off the air conditioner in someone else’s office, no matter how uncomfortable it made me. Furthermore, I would be shocked, if another man were to do so. The proper behavior is what you did, asking the person whose office it was to turn off the air conditioner. The response you received was appalling. Rather than reflecting sexism by all physicians, that physician’s comments show not only that he, himself, was a jerk, but that he had so little insight that he thought everyone else behaved the same way he would. You correctly criticize most physicians for not having the insight to ask functional questions pertinent to pain, but that applies equally to men and to women. Having first-hand experience with the medical community’s intense biases against, and criticisms of, efforts to systematically assess and acknowledge that pain is more than just a feeling, I can tell you that this is a far different (and bigger) problem than the sexism that you imagine it to be. Questions about depression are not inappropriate… Read more »