Women less likely to be prescribed pain medications

Key takeaways:

• Women also spent longer times in EDs and were less likely to receive pain medications vs. men.
• Insufficient pain management could lead to unnecessary suffering and preventable costs, researchers said.

Women are less likely to be prescribed pain relief medications compared with men when treated in EDs, findings from a retrospective analysis published in Proceedings of the National Academy of Sciences suggested.

The results may be attributed to gender stereotypes in pain perception, according to study investigators.

“Recent psychological research suggests that the biased perception of pain stems from a ‘gender-pain exaggeration bias’: Women are believed to report their pain in an exaggerated manner compared to men,” Mika Guzikevits, from the Hebrew University of Jerusalem in Israel, and colleagues wrote. “Such gendered pain perception may affect pain management decisions, resulting in less pain treatment for women.”

The researchers explored this theory by analyzing datasets (n = 21,851) from two EDs in the United States and Israel that included discharge notes of patients arriving with pain complaints.

The datasets revealed that female patients less frequently received prescriptions for any type of pain relief medications — both opioids and nonopioids — compared with male patients, even after researchers adjusted for pain scores and patient, ED and physician variables.

Women received fewer medications regardless of pain score or age, whereas both male and female physicians prescribed pain relief medications less frequently to women than to men.

Further analyses showed that women’s pain scores were 10% less likely to be recorded by nurses — despite it being recommended that all patients have pain scores recorded, the researchers pointed out — whereas women spent an additional 30 minutes in the ED compared with men.

Guzikevits and colleagues confirmed their findings in a controlled experiment where nurses (n = 109) were presented with a brief clinical scenario involving a patient arriving at the ED with back pain, which the patient rated as 9 out of 10.

“The scenario described the patient as either female or male but was otherwise identical,” they wrote.

The nurses ultimately rated the pain as less intense for women compared with men.

The findings have significant implications, as “inadequate pain management is known to lead to unnecessary suffering and deleterious health effects and also carries preventable costs for public health,” the researchers wrote.

They highlighted several possible solutions for addressing bias, which include:

• providing treatment by same-sex clinicians;
• computerized decision-support tools that clinicians to provide pain medications and record pain scores;
• raising clinicians’ awareness of sex bias in pain medication prescribing.

“Future research should explore these potential debiasing tools,” Guzikevits and colleagues concluded.

References:

• Sex bias in pain management at emergency departments new study reveals. https://www.eurekalert.org/news-releases/1053656. Published Aug. 5, 2024. Accessed Aug. 7, 2024.
• Guzikevits M, et al. Proc Natl Acad Sci U S A. 2024;doi:10.1073/pnas.2401331121.