Pain

Women’s pain is underrecognized and undertreated. In the ER, when women and men describe the same severity of abdominal pain, men wait an average of 49 minutes before being treated, while the average wait for women is 65 minutes. Similarly, women are consistently prescribed less pain-relieving medication, even when controls for weight are applied.

This healthcare worker bias is even more marked for people of colour. Black patients are significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain. This disparity in pain treatment is true even among young children. 

Studies of physician behaviour show doctors are more likely to think women’s pain is caused by emotional issues rather than physical causes, even in the presence of clinical tests which show their pain is real. As a result, women with chronic pain conditions are more likely to be wrongly labeled with mental health diagnoses than men and more likely to be prescribed sedatives rather than analgesics. 

People with pain, especially from marginalized groups, often feel dismissed by their care providers and indeed often leave the encounter without a plan for resolving their symptoms. I don’t have a solution to end gender bias across societies, but what I can offer is a framework for describing pain to your physician to help us accurately diagnose your issue.

Pain from our internal organs is poorly localized. Pain from the uterus and pain from the sigmoid colon all goes through the same nerve bundles so crampy pelvic pain does not automatically mean there’s a gynecologic issue, even if it feels like menstrual cramps. Pelvic floor muscle tesion can even mimic bladder infection. There’s a lot of stuff going on in the pelvis and many potential pain sources.

It’s human nature to look for patterns and explanations but bringing your pre-conceived notions about what you think is causing your pain is much less helpful than accurately describing your symptoms. Women often tell me about pain that is clearly gastrointestinal in origin. They’ve often never discussed it with their family doctor because they’d assumed their pain was from their lady parts. 

The next important tool is your pain diary. I like the one available here. Keep a journal of how often the pain comes. This is a good printable resource, and if you’re menstruating I would add day of cycle beside day of the week. Is it related to your period? Does it come at the same time every month?

Rate it on the pain scale from 1-10. Be clear with your care team about how the pain impacts you. If you’re missing work or in the fetal position at Walmart, please communicate that clearly.

How does it feel and where exactly is it? Is it a sudden spasm, or a dull throb? Does it ache or pinch? Do you feel it in your tailbone or your belly button? In the middle or on one side? Same place every time or different places?

When the pain comes, how long does it last? 2 seconds or 3 hours or 2 days?

Is it related to eating? Do you notice nausea, diarrhea or constipation when the pain is worse? 

Does anything make it better, or worse? 

If your pain is 8-10 and won’t go away, it’s time to go to ER. Otherwise, bring at least 2 months worth of pain reporting to your family doctor.  Make sure that you leave your appointment with a clear plan to improve your pain. That plan may include a trial of medications, or further testing. 

Other ways to help your doctor help you:

• People tend to try a new medication for a week or two, decide it doesn’t work and give up. Book a followup visit to assess the plan and keep following the plan until then. You may see improvement over time, and if not your doc will often have other interventions to try. 

• Bring all of your medications. I can’t tell you how often a patient says “I tried a cream and it helped but I don’t remember what it was”. Then they spend 5 minutes unsuccessfully trying to find it in the photo album of their phone. 

• Be organized. Complex systems fail in complex ways. Hospitals close and records are lost. Ask for copies of your Operative Notes and Surgical Pathology Reports. If you’re seeing multiple specialists start a binder to keep track of what’s been done and what’s still pending. 

• If your care team has been unable to fully resolve your pain, start working with a chronic pain clinic on the mind-body connection. The brain can continue to perceive discomfort even after the initial cause of pain is treated and resolved. It doesn’t mean your doc thinks you’re crazy, it means pain lives in the brain and sometimes brain re-training is the best approach.