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The Woman Who Cried Pain: Do Sex-Based Disparities Still Exist in the Experience and Treatment of Pain?

Published online by Cambridge University Press:  18 November 2022

Diane E. Hoffmann
Affiliation:
UNIVERSITY OF MARYLAND, BALTIMORE, MD, USA
Roger B. Fillingim
Affiliation:
UNIVERSITY OF FLORIDA, GAINESVILLE, FL, USA
Christin Veasley
Affiliation:
CHRONIC PAIN RESEARCH ALLIANCE, MILWAUKEE WI, USA.

Abstract

Over twenty years have passed since JLME published “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.” This article revisits the conclusions drawn in that piece and explores what we have learned in the last two decades regarding the experience of men and women who have chronic pain and whether women continue to be treated less aggressively for their pain than men.

Type
Independent Articles
Copyright
© 2022 The Author(s)

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References

Hoffmann, D. E. and Tarzian, A. J., “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” Journal of Law, Medicine & Ethics 29, no. 1 (2001): 1327.Google Scholar
Calderone, K. L., “The Influence of Gender on the Frequency of Pain and Sedative Medication Administered to Postoperative Patients,” Sex Roles 23, no. 11-12 (1990): 713–25.Google Scholar
Hoffmann and Tarzian, supra note 1, at 13.Google Scholar
Miaskowski, G., “Women and Pain,” Critical Care Nursing Clinics of North America 9, no. 4 (1997): 453458. See also P. A. Johnson, L. Goldman, E. J. Orav et al., “Gender Differences in the Management of Acute Chest Pain: Support for the ‘Yentl Syndrome,’” Journal of General Internal Medicine 11, no. 4 (1996): 209–217.Google ScholarPubMed
Hadjistavropoulos, T., McMurtry, B., and Craig, K. D., “Beautiful Faces in Pain: Biases and Accuracy in the Perception of Pain,” Psychology and Health 11, no. 3 (1996): 411420.Google Scholar
Canadian Institutes of Health Research, “Definitions of Sex and Gender,” available at <https://cihr-irsc.gc.ca/e/47830.html> (last visited October 18, 2021), cited in Boerner, K. E., Chambers, C. T., Gahagan, J., Keogh, E., Fillingim, R. B., and Mogil, J. S., “Conceptual Complexity of Gender and Its Relevance to Pain,” Pain 159, no. 11 (2018): 21372141 (describing sex as a “set of biological attributes … primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy”).CrossRefGoogle ScholarPubMed
Montañez, A., “Visualizing Sex as a Spectrum,” Scientific American Blog, August 29, 2017, available at <https://blogs.scientificamerican.com/sa-visual/visualizing-sex-as-a-spectrum/> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Gender Spectrum, “Understanding Gender,” available at <https://genderspectrum.org/articles/understanding-gender> (last visited November 1, 2021).+(last+visited+November+1,+2021).>Google Scholar
Strath, L. J., Sorge, R. E., Owens, M. A., Gonzalez, C. E., Okunbor, J. I., White, D. M., Merlin, J. S., and Goodin, B. R., “Sex and Gender Are Not the Same: Why Identity Is Important for People Living with HIV and Chronic Pain,” Journal of Pain Research 13 (2020): 829835, available at <https://doi.org/10.2147/JPR.S248424> (last visited July 25, 2022).Google ScholarPubMed
Clayton, J. A. and Collins, F. S., “Policy: NIH to Balance Sex in Cell and Animal Studies,” Nature 509, no. 7500 (2014): 282283.Google ScholarPubMed
NIH, “History of Women’s Participation in Clinical Research,” available at <https://orwh.od.nih.gov/toolkit/recruitment/history> (last visited October 18, 2021).+(last+visited+October+18,+2021).>Google Scholar
This is the case unless exclusion of one sex can be scientifically justified.Google Scholar
Mogil, J. S., “Animal Models of Pain: Progress and Challenges,” Nature Reviews Neuroscience 10, no. 4 (2009): 283294.Google ScholarPubMed
Woolf, C. J., “Central Sensitization: Implications for the Diagnosis and Treatment of Pain,” Pain 152, no. 3 Supp. (2011): S2S15.Google ScholarPubMed
Woolf, C. J., “Evidence for a Central Component of Post-Injury Pain Hypersensitivity,” Nature 306, no. 5944 (1983): 686688.Google ScholarPubMed
Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J. A., Rice, A. S. C., Rief, W., and Sluka, A. K., “Do We Need a Third Mechanistic Descriptor for Chronic Pain States?Pain 157, no. 7 (2016): 13821386.Google Scholar
Harper, D. E., Schrepf, A., and Clauw, D. J., “Pain Mechanisms and Centralized Pain in Temporomandibular Disorders,” Journal of Dental Research 95, no. 10 (2016): 11021108.Google ScholarPubMed
Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., and Riley, J. L., “Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings,” The Journal of Pain 10, no. 5 (2009): 447485.CrossRefGoogle Scholar
Coppieters, I., Meeus, M., Kregel, J., Caeyenberghs, K., De Pauw, R., Goubert, D., and Cagnie, B., “Relations Between Brain Alterations and Clinical Pain Measures in Chronic Musculoskeletal Pain: A Systematic Review,” The Journal of Pain 17, no. 9 (2016): 949962.Google ScholarPubMed
Maixner, W., Fillingim, R. B., Williams, D. A., Smith, S. B., and Slade, G. D., “Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification,” The Journal of Pain 17, no. 9 Supp. (2016): T93T107.Google ScholarPubMed
Mun, C. J., Ruehlman, L., and Karoly, P., “Examining the Adjustment Patterns of Adults with Multiple Chronic Pain Conditions and Multiple Pain Sites: More Pain, No Gain,” The Journal of Pain 21, no. 1-2 (2020): 108120.CrossRefGoogle ScholarPubMed
Fillingim, R. B., Ohrbach, R., Greenspan, J. D., Sanders, A. E., Rathnayaka, N., Maixner, W. and Slade, G. D., “Associations of Psychologic Factors with Multiple Chronic Overlapping Pain Conditions,” Journal of Oral & Facial Pain and Headache 34, Supp. (2020): s85s100.Google ScholarPubMed
Edwards, R. R., Dworkin, R. H., Turk, D. C., Angst, M. S., Dionne, R., Freeman, R., Hansson, P. et al., “Patient Phenotyping in Clinical Trials of Chronic Pain Treatments: IMMPACT Recommendations,” Pain 157, no. 9 (2016): 18511871.Google ScholarPubMed
Slade, G. D., Ohrbach, R., Greenspan, J. D., Fillingim, R. B., Bair, E., Sanders, A. E., Dubner, R. et al., “Painful Temporomandibular Disorder: Decade of Discovery from OPPERA Studies,” Journal of Dental Research 95, no. 10 (2016): 10841092.Google ScholarPubMed
Bair, E., Gaynor, S., Slade, G. D., Ohrbach, R., Fillingim, R. B., Greenspan, J. D., Dubner, R., Smith, S. B., Diatchenko, L., and Maixner, W., “Identification of Clusters of Individuals Relevant to Temporomandibular Disorders and Other Chronic Pain Conditions: The OPPERA Study,” Pain 157, no. 6 (2016): 12661278.Google ScholarPubMed
Yim, Y. R., Lee, K. E., Park, D. J., Kim, S. H., Nah, S. S., Lee, J. H., Kim, S. K. et al., “Identifying Fibromyalgia Subgroups Using Cluster Analysis: Relationships with Clinical Variables,” European Journal of Pain 21, no. 2 (2017): 374384.Google ScholarPubMed
Braun, A., Evdokimov, D., Frank, J., Pauli, P., Uceyler, N. and Sommer, C., “Clustering Fibromyalgia Patients: A Combination of Psychosocial and Somatic Factors Leads to Resilient Coping in a Subgroup of Fibromyalgia Patients,” PloS One 15, no. 12 (2020): e0243806, available at <https://doi.org/10.1371/journal.pone.0243806> (last visited July 25, 2022).Google Scholar
Craft, R. M., “Modulation of Pain by Estrogens,” Pain 132, Supp. 1 (2007): S3S12.Google ScholarPubMed
McCarthy, M. M., Arnold, A. P., Ball, G. F., Blaustein, J. D., and De Vries, G. J., “Sex Differences in the Brain: The Not So Inconvenient Truth,” The Journal of Neuroscience 32, no. 7 (2012): 22412247.CrossRefGoogle ScholarPubMed
Yamamoto, K., Okazaki, A., Sakamoto, Y., and Funatsu, M., “The Relationship Between Premenstrual Symptoms, Menstrual Pain, Irregular Menstrual Cycles, and Psychosocial Stress Among Japanese College Students,” Journal of Physiological Anthropology 28, no. 3 (2009): 129136.Google ScholarPubMed
Wijnhoven, H. A. H., de Vet, H. C. W., Smit, H. A., and Picavet, H. S., “Hormonal and Reproductive Factors Are Associated with Chronic Low Back Pain and Chronic Upper Extremity Pain in Women—The MORGEN study,” Spine 31, no. 13 (2006): 14961502.Google ScholarPubMed
Latthe, P., Mignini, L., Gray, R., Hills, R., and Khan, K., “Factors Predisposing Women to Chronic Pelvic Pain: Systematic Review,” BMJ 332, no. 7544 (2006): 749755.CrossRefGoogle ScholarPubMed
Pogatzki-Zahn, E. M., Drescher, C., Englbrecht, J. S., Klein, T., Magerl, W., and Zahn, P. K., “Progesterone Relates to Enhanced Incisional Acute Pain and Pinprick Hyperalgesia in the Luteal Phase of Female Volunteers,” Pain 160, no. 8 (2019): 17811793.Google ScholarPubMed
Dawson-Basoa, M. and Gintzler, A. R., “Gestational and Ovarian Sex Steroid Antinociception: Synergy Between Spinal Kappa and Delta Opioid Systems,” Brain Research 794, no. 1 (1998): 6167.Google ScholarPubMed
LeResche, L., Sherman, J. J., Huggins, K., Saunders, K., Mancl, L. A., Lentz, G., and Dworkin, S. F., “Musculoskeletal Orofacial Pain and Other Signs and Symptoms of Temporomandibular Disorders During Pregnancy: A Prospective Study,” Journal of Orofacial Pain 19, no. 3 (2005): 193201; G. Sances, F. Granella, R. E. Nappi, A. Fignon, N. Ghiotto, F. Polatti, and G. Nappi, “Course of Migraine During Pregnancy and Postpartum: A Prospective Study,” Cephalalgia 23, no. 3 (2003): 197–205; T. Rezaii and M. Ernberg, “Influence of Oral Contraceptives on Endogenous Pain Control in Healthy Women,” Experimental Brain Research 203, no. 2 (2010): 329–338; M. M. Máximo, P. S. Silva, C. S. Vieira, T. M. Gonçalvez, J. C. Rosa-E-Silva, F. J. Candido-Dos-Reis, A. A. Nogueira, and O. B. Poli-Neto, “Low-Dose Progestin-Releasing Contraceptives Are Associated with a Higher Pain Threshold in Healthy Women,” Fertility and Sterility 104, no. 5 (2015): 1182–1189.Google ScholarPubMed
Melchior, M., Poisbeau, P., Gaumond, I., and Marchand, S., “Insights into the Mechanisms and the Emergence of Sex-Differences in Pain,” Neuroscience 338 (2016): 6380.CrossRefGoogle ScholarPubMed
Bartley, E. J., Palit, S., Kuhn, B. L., Kerr, K. L., Terry, E. L., DelVentura, J. L., and Rhudy, J. L., “Natural Variation in Testosterone Is Associated with Hypoalgesia in Healthy Women,” The Clinical Journal of Pain 31, no. 8 (2015): 730739; J. C. Choi, M. I. Chung, and Y. D. Lee, “Modulation of Pain Sensation by Stress-Related Testosterone and Cortisol,” Anaesthesia 67, no. 10 (2012): 1146–1151; J. C. Choi, Y.-H. Park, S. K. Park, J. S. Lee, J. Kim, J. I. Choi, K. B. Yoon et al., “Testosterone Effects on Pain and Brain Activation Patterns,” Acta Anaesthesiologica Scandinavica 61, no. 6 (2017): 668–675.CrossRefGoogle ScholarPubMed
Ribeiro-Dasilva, M. C., Shinal, R. M., Glover, T., Williams, R. S., Staud, R., Riley, J. L. III and Fillingim, R. B., “Evaluation of Menstrual Cycle Effects on Morphine and Pentazocine Analgesia,” Pain 152, no. 3 (2011): 614622.CrossRefGoogle ScholarPubMed
Freystaetter, G., Fischer, K., Orav, E. J., Egli, A., Theiler, R., Münzer, T., Felson, D. T., and Bischoff-Ferrari, H. A., “Total Serum Testosterone and Western Ontario and McMaster Universities Osteoarthritis Index Pain and Function Among Older Men and Women With Severe Knee Osteoarthritis,” Arthritis Care and Research 72, no. 11 (2020): 15111518.Google ScholarPubMed
Schertzinger, M., Wesson-Sides, K., Parkitny, L., and Younger, J., “Daily Fluctuations of Progesterone and Testosterone Are Associated with Fibromyalgia Pain Severity,” The Journal of Pain 19, no. 4 (2018): 410417.CrossRefGoogle ScholarPubMed
Mogil, J. S., “Qualitative Sex Differences in Pain Processing: Emerging Evidence of a Biased Literature,” Nature Reviews Neuroscience 21, no. 7 (2020): 353365.Google ScholarPubMed
Mogil, J. S., Wilson, S. G., Chesler, E. J., Rankin, A. L., Nemmani, K. V. S., Lariviere, W. R., Groce, M. K. et al., “The Melanocortin-1 Receptor Gene Mediates Female-Specific Mechanisms of Analgesia in Mice and Humans,” Proceedings of the National Academy of Sciences of the USA 100, no. 8 (2003): 48674872; R. B. Fillingim, L. Kaplan, R. Staud, T. J. Ness, T. L. Glover, C. M. Campbell, J. S. Mogil, and M. R. Wallace, “The A118G Single Nucleotide Polymorphism of the mu-Opioid Receptor Gene (OPRM1) Is Associated with Pressure Pain Sensitivity in Humans,” The Journal of Pain 6, no. 3 (2005): 159–167; M. B. Olsen, L. M. Jacobsen, E. I. Schistad, L. M. Pedersen, L. J. Rygh, C. Røe, and J. Gjerstad, “Pain Intensity the First Year After Lumbar Disc Herniation Is Associated with the A118G Polymorphism in the Opioid Receptor Mu 1 Gene: Evidence of a Sex and Genotype Interaction,” The Journal of Neuroscience 32, no. 29 (2012): 9831–9834.Google ScholarPubMed
Mogil, supra note 42.Google Scholar
Avona, A., Burgos-Vega, C., Burton, M. D., Akopian, A. N., Price, T. J., and Dussor, G., “Dural Calcitonin Gene-Related Peptide Produces Female-Specific Responses in Rodent Migraine Models,” The Journal of Neuroscience 39, no. 22 (2019): 43234331.CrossRefGoogle ScholarPubMed
Mogil, supra note 42.Google Scholar
Halievski, K., Ghazisaeidi, S., and Salter, M. W., “Sex-Dependent Mechanisms of Chronic Pain: A Focus on Microglia and P2X4R,” The Journal of Pharmacology and Experimental Therapeutics 375, no. 1 (2020): 202209; S. Rosen, B. Ham, and J. S. Mogil, “Sex Differences in Neuroimmunity and Pain,” Journal of Neuroscience Research 95, no. 1-2 (2017): 500–508.Google ScholarPubMed
Rosen, S., Ham, B., and Mogil, J. S., “Sex Differences in Neuroimmunity and Pain,” Journal of Neuroscience Research 95, no. 1-2 (2017): 500508; R. E. Sorge, J. C. S. Mapplebeck, S. Rosen, S. Beggs, S. Taves, J. K. Alexander, L. J. Martin et al., “Different Immune Cells Mediate Mechanical Pain Hypersensitivity in Male and Female Mice,” Nature Neuroscience 18, no. 8 (2015): 1081–1083.Google ScholarPubMed
Noor, S., Sun, M. S., Vanderwall, A. G., Havard, M. A., Sanchez, J. E., Harris, N. W., Nysus, M. V. et al., “LFA-1 Antagonist (BIRT377) Similarly Reverses Peripheral Neuropathic Pain in Male and Female Mice with Underlying Sex Divergent Peripheral Immune Proinflammatory Phenotypes,” Neuroimmunology and Neuroinflammation 6 (2019): art. no. 10, doi: 10.20517/2347-8659.2019.18; V. L. Tawfik, N. A. Huck, Q. J. Baca, E. A. Ganio, E. S. Haight, A. Culos, S. Ghaemi et al., “Systematic Immunophenotyping Reveals Sex-Specific Responses After Painful Injury in Mice,” Frontiers in Immunology 11 (2020): art. no. 1652, https://doi.org/10.3389/fimmu.2020.01652Google ScholarPubMed
Lasselin, J., Lekander, M., Axelsson, J., and Karshikoff, B., “Sex Differences in How Inflammation Affects Behavior: What We Can Learn from Experimental Inflammatory Models in Humans,” Frontiers in Neuroendocrinology 50 (2018): 91106.CrossRefGoogle ScholarPubMed
Coppieters et al., supra note 20.Google Scholar
Gupta, A., Mayer, E. A., Fling, C., Labus, J. S., Naliboff, B. D., Hong, J. Y., and Kilpatrick, L. A., “Sex-Based Differences in Brain Alterations Across Chronic Pain Conditions,” Journal of Neuroscience Research 95, no. 1-2 (2017): 604616; D. Reckziegel, T. Abdullah, B. Wu, B. Wu, L. Huang, T. J. Schnitzer, and A. V. Apkarian, “Hippocampus Shape Deformation: A Potential Diagnostic Biomarker for Chronic Back Pain in Women,” Pain 162, no. 5 (2021): 1457–1467; Z. Jiang, I. D. Dinov, J. Labus, Y. Shi, A. Zamanyan, A. Gupta, C. Ashe-McNalley et al., “Sex-Related Differences of Cortical Thickness in Patients with Chronic Abdominal Pain,” PloS One 8, no. 9 (2013): e73932; V. Faria, N. Erpelding, A. Lebel, A. Johnson, R. Wolff, D. Fair, R. Burstein, L. Becerra, and D. Borsook, “The Migraine Brain in Transition: Girls vs Boys,” Pain 156, no. 11 (2015): 2212–2221.Google ScholarPubMed
Pfannmöller, J. and Lotze, M., “Review on Biomarkers in the Resting-State Networks of Chronic Pain Patients,” Brain and Cognition 131, no. 1 (2019): 49.Google ScholarPubMed
Coulombe, M.- A., Erpelding, N., Kucyi, A., and Davis, K. D., “Intrinsic Functional Connectivity of Periaqueductal Gray Subregions in Humans,” Human Brain Mapping 37, no. 4 (2016): 15141530; G. Wang, N. Erpelding, and K. D. Davis, “Sex Differences in Connectivity of the Subgenual Anterior Cingulate Cortex,” Pain 155, no. 4 (2014): 755–763; N. R. Osborne, J. C. Cheng, A. Rogachov, J. A. Kim, K. S. Hemington, R. L. Bosma, R. D. Inman, and K. D. Davis, “Abnormal Subgenual Anterior Cingulate Circuitry Is Unique to Women but not Men with Chronic Pain,” Pain 162, no. 1 (2021): 97–108.Google ScholarPubMed
Pisanu, C., Franconi, F., Gessa, G. L., Mameli, S., Pisanu, G. M., Campesi, I., Leggio, L., and Agabio, R., “Sex Differences in the Response to Opioids for Pain Relief: A Systematic Review and Meta-Analysis,” Pharmacological Research 148 (2019): art. no. 104447, https://doi.org/10.1016/j.phrs.2019.104447.Google ScholarPubMed
Mogil, supra note 42.Google Scholar
Niesters, M., Dahan, A., Kest, B., Zacny, J., Stijnen, T., Aarts, L., and Sarton, E., “Do Sex Differences Exist in Opioid Analgesia? A Systematic Review and Meta-Analysis of Human Experimental and Clinical Studies,” Pain 151, no. 1 (2010): 6168; Pisanu et al., supra note 57.CrossRefGoogle ScholarPubMed
Riley, J. L. III, Hastie, B. A., Glover, T. L., Fillingim, R. B., Staud, R., and Campbell, C. M., “Cognitive-Affective and Somatic Side Effects of Morphine and Pentazocine: Side-Effect Profiles in Healthy Adults,” Pain Medicine 11, no. 2 (2010): 195206; J. P. Zacny, “Morphine Responses in Humans: A Retrospective Analysis of Sex Differences,” Drug and Alcohol Dependence 63, no. 1 (2001): 23–28.CrossRefGoogle ScholarPubMed
Coluzzi, F., Billeci, D., Maggi, M., and Corona, G., “Testosterone Deficiency in Non-Cancer Opioid-Treated Patients,” Journal of Endocrinological Investigation 41, no. 12 (2018): 13771388; S. Marudhai, M. Patel, S. V. Subas, M. R. Ghani, V. Busa, A. Dardeir, and I. Cancarevic, “Long-term Opioids Linked to Hypogonadism and the Role of Testosterone Supplementation Therapy,” Cureus 12, no. 10 (2020): e10813.Google ScholarPubMed
Hoopsick, R. A., Homish, G. G., and Leonard, K. E., “Differences in Opioid Overdose Mortality Rates Among Middle-Aged Adults by Race/Ethnicity and Sex, 1999-2018,” Public Health Reports 136, no. 2 (2021): 192200; E. R. Silver and C. Hur, “Gender Differences in Prescription Opioid Use and Misuse: Implications for Men’s Health and the Opioid Epidemic,” Preventive Medicine 131 (2020): art. no. 105946, doi 10.1016/j.ypmed.2019.105946.CrossRefGoogle Scholar
Brady, J. E., Giglio, R., Keyes, K. M., DiMaggio, C., and Li, G., “Risk Markers for Fatal and Non-Fatal Prescription Drug Overdose: A Meta-Analysis,” Injury Epidemiology 4, no. 1 (2017): art. no. 24, doi 10.1186/s40621-017-0118-7; E. Kaplovitch, T. Gomes, X. Camacho, I. A. Dhalla, M. M. Mamdani, and D. N. Juurlink, “Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study,” PloS One 10, no. 8 (2015): e0134550.Google ScholarPubMed
Blanton, H. L., Barnes, R. C., McHann, M. C., Bilbrey, J. A., Wilkerson, J. L., and Guindon, J., “Sex Differences and the Endocannabinoid System in Pain,” Pharmacology, Biochemistry, and Behavior 202 (2021): art. no. 173107, doi: 10.1016/j.pbb.2021.173107.CrossRefGoogle ScholarPubMed
Cooper, Z. D. and Craft, R. M., “Sex-Dependent Effects of Cannabis and Cannabinoids: A Translational Perspective,” Neuropsychopharmacology 43, no. 1 (2018): 3451.Google ScholarPubMed
Colloca, L. and Barsky, A. J., “Placebo and Nocebo Effects,” New England Journal of Medicine 382, no. 6 (2020): 554561.Google ScholarPubMed
Enck, P. and Klosterhalfen, S., “Does Sex/Gender Play a Role in Placebo and Nocebo Effects? Conflicting Evidence from Clinical Trials and Experimental Studies,” Frontiers in Neuroscience 13 (2019): art. no. 160, doi.org/10.3389/fnins.2019.00160; S. M. Vambheim and M. A. Flaten, “A Systematic Review of Sex Differences in the Placebo and the Nocebo Effect,” Journal of Pain Research 10 (2017): 1831–1839.Google ScholarPubMed
Mogil, J. S., “Sex Differences in Pain and Pain Inhibition: Multiple Explanations of a Controversial Phenomenon,” Nature Reviews Neuroscience 13, no. 12 (2012): 859866; Fillingim et al., supra note 19; Mogil, supra note 42.Google ScholarPubMed
Alabas, O. A., Tashani, O. A., Tabasam, G., and Johnson, M. I., “Gender Role Affects Experimental Pain Responses: A Systematic Review with Meta-Analysis,” European Journal of Pain 16, no. 9 (2012): 12111223; G. J. Pool, A. F. Schwegler, B. R. Theodore, and P. N. Fuchs, “Role of Gender Norms and Group Identification on Hypothetical and Experimental Pain Tolerance,” Pain 129, no. 1-2 (2007): 122–129; M. Racine, Y. Tousignant-Laflamme, L. A. Kloda, D. Dion, G. Dupuis, and M. Choinière, “A Systematic Literature Review of 10 Years of Research on Sex/Gender and Pain Perception - Part 2: Do Biopsychosocial Factors Alter Pain Sensitivity Differently in Women and Men?” Pain 153, no. 3 (2012): 619–635.Google ScholarPubMed
Robinson, M. E., Gagnon, C. M., Dannecker, E. A., Brown, J. L., Jump, R. L., and Price, D. D., “Sex Differences in Common Pain Events: Expectations and Anchors,” The Journal of Pain 4, no. 1 (2003): 4045; M. Kunz, A. Gruber, and S. Lautenbacher, “Sex Differences in Facial Encoding of Pain,” The Journal of Pain 7, no. 12 (2006): 915–928; M. E. Robinson, J. L. Riley 3rd, C. D. Myers, R. K. Papas, E. A. Wise, L. B. Waxenberg, and R. B. Fillingim, “Gender Role Expectations of Pain: Relationship to Sex Differences in Pain,” The Journal of Pain 2, no. 5 (2001): 251–257.Google ScholarPubMed
Hines, M., “Human Gender Development,” Neuroscience and Biobehavioral Reviews 118, special issue (2020): 8996.CrossRefGoogle Scholar
Robinson, M. E., Gagnon, C. M., Riley, J. L., and Price, D. D., “Altering Gender Role Expectations: Effects on Pain Tolerance, Pain Threshold, and Pain Ratings,” The Journal of Pain 4, no. 5 (2003): 284–248; S. L. Fowler, H. M. Rasinski, A. L. Geers, S. G. Helfer, and C. R. France, “Concept Priming and Pain: An Experimental Approach to Understanding Gender Roles in Sex-Related Pain Differences,” Journal of Behavioral Medicine 34, no. 2 (2011): 139–147; Racine et al., supra note 70.Google ScholarPubMed
Bartley, E. J. and Fillingim, R. B., “Sex Differences in Pain: A Brief Review of Clinical and Experimental Findings,” British Journal of Anaesthesia 111, no. 1 (2013): 5258.Google Scholar
Catastrophizing refers to a pattern of negative thinking related to pain that involves tendencies to focus intently on the pain and to feel helpless in the face of pain. This term has come to be viewed as pejorative and can be stigmatizing to people experiencing pain. While we support ongoing efforts to replace this term with a more useful one, we use it here not as an endorsement, but because it has been used by the authors of the studies we describe.Google Scholar
Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., and Lefebvre, J. C., “Theoretical Perspectives on the Relation Between Catastrophizing and Pain,” Clinical Journal of Pain 17, no. 1 (2001): 5264.Google ScholarPubMed
Racine et al., supra note 70.Google Scholar
Jackson, T., Iezzi, T., Chen, H., Ebnet, S., and Eglitis, K., “Gender, Interpersonal Transactions, and the Perception of Pain: An Experimental Analysis,” Journal of Pain 6, no. 4 (2005): 228236.Google ScholarPubMed
Vigil, J. M., Rowell, L. N., Chouteau, S., Chavez, A., Jaramillo, E., Neal, M., and Waid, D., “Sex Differences in How Social Networks and Relationship Quality Influence Experimental Pain Sensitivity,” PLoS One 8, no. 11 (2013): e78663.Google ScholarPubMed
IsHak, W. W., Wen, R. Y., Naghdechi, L., Vanle, B., Dang, J., Knosp, M., Dascal, J., et al., “Pain and Depression: A Systematic Review,” Harvard Review of Psychiatry 26, no. 6 (2018): 352363; B. Stubbs, D. Vancampfort, N. Veronese, T. Thompson, M. Fornaro, P. Schofield, M. Solmi, et al., “Depression and Pain: Primary Data and Meta-Analysis Among 237,952 People Across 47 Low- and Middle-Income Countries,” Psychological Medicine 47, no. 16 (2017): 2906–2917; M. L. Seney and E. Sibille, “Sex Differences in Mood Disorders: Perspectives from Humans and Rodent Models,” Biology of Sex Differences 7, no. 5 (2014): art. no. 17, doi: 10.1186/s13293-014-0017-3; A. Labaka, O. Goñi-Balentziaga, A. Lebeña and J. Pérez-Tejada, “Biological Sex Differences in Depression: A Systematic Review,” Biological Research for Nursing 20, no. 4 (2018): 383–392.Google ScholarPubMed
Bair, M. J., Robinson, R. L., Katon, W., and Kroenke, K., “Depression and Pain Comorbidity: A Literature Review,” Archives of Internal Medicine 163, no. 20 (2003): 24332445.Google ScholarPubMed
Racine et al., supra note 70.Google Scholar
Buttner, M. M., Godfrey, K. M., Floto, E., Pittman, J., Lindamer, L., and Afari, N., “Combat Exposure and Pain in Male and Female Afghanistan and Iraq Veterans: The Role of Mediators and Moderators,” Psychiatry Research 257 (2017): 713.Google ScholarPubMed
Patel, R., Biros, M. H., Moore, J., and Miner, J. R., “Gender Differences in Patient-Described Pain, Stress, and Anxiety Among Patients Undergoing Treatment for Painful Conditions in the Emergency Department,” Academic Emergency Medicine 21, no. 12 (2014): 14781484.CrossRefGoogle ScholarPubMed
Canales, G. T., Guarda-Nardini, L., Rizzatti-Barbosa, C. M., Conti, P. C. R., and Manfredini, D., “Distribution of Depression, Somatization and Pain-Related Impairment in Patients with Chronic Temporomandibular Disorders,” Journal of Applied Oral Science 27 (2019): e20180210, doi: 10.1590/1678-7757-2018-0210.Google ScholarPubMed
García-Esquinas, E., Rodríguez-Sánchez, I., Ortolá, R., Lopez-Garcia, E., Caballero, F. F., Rodríguez-Mañas, L., Banegas, J. R., and Rodríguez-Artalejo, F., “Gender Differences in Pain Risk in Old Age: Magnitude and Contributors,” Mayo Clinic Proceedings 94, no. 9 (2019): 17071717.Google ScholarPubMed
Nandi, M., Schreiber, K. L., Martel, M. O., Cornelius, M., Campbell, C. M., Haythornthwaite, J. A., Smith, M. T. Jr. et al., “Sex Differences in Negative Affect and Postoperative Pain in Patients Undergoing Total Knee Arthroplasty,” Biology of Sex Differences 10, no. 1 (2019): art. no. 23, doi: 10.1186/s13293-019-0237-7.Google ScholarPubMed
Groenewald, C. B., Murray, C. B., and Palermo, T. M., “Adverse Childhood Experiences and Chronic Pain Among Children and Adolescents in the United States,” Pain Reports 5, no. 5 (2020): e839, doi: 10.1097/PR9.0000000000000839; A. Stickley, A. Koyanagi, N. Kawakami and WHO World Mental Health Japan Survey Group, “Childhood Adversities and Adult-Onset Chronic Pain: Results from the World Mental Health Survey, Japan,” European Journal of Pain 19, no. 10 (2015): 1418-1427.Google ScholarPubMed
Brennenstuhl, S. and Fuller-Thomson, E., “The Painful Legacy of Childhood Violence: Migraine Headaches Among Adult Survivors of Adverse Childhood Experiences,” Headache 55, no. 7 (2015): 973–83; Z. Giano, D. L. Wheeler, and R. D. Hubach, “The Frequencies and Disparities of Adverse Childhood Experiences in the U.S.,” BMC Public Health 20, no. 1 (2020): art. no. 1327, doi: 10.1186/s12889-020-09411-z.Google ScholarPubMed
Prusator, D. K. and Greenwood-Van Meerveld, B., “Sex-Related Differences in Pain Behaviors Following Three Early Life Stress Paradigms,” Biology of Sex Differences 7 (2016): art. no. 29, doi: 10.1186/s13293-016-0082-x.CrossRefGoogle ScholarPubMed
Nishinaka, T., Kinoshita, M., Nakamoto, K., and Tokuyama, S., “Sex Differences in Depression-Like Behavior After Nerve Injury Are Associated with Differential Changes in Brain-Derived Neurotrophic Factor Levels in Mice Subjected to Early Life Stress,” Neuroscience Letters 592 (2015): 3236.Google ScholarPubMed
Prusator and Greenwood-Van Meerveld, supra note 90.Google Scholar
Hashmi, H. A. and Davis, K. D., “Deconstructing Sex Differences in Pain Sensitivity,” Pain 155, no. 1 (2014): 1013.Google ScholarPubMed
Mogil, J. S., Sorge, R. E., LaCroix-Fralish, M. L., Smith, S. B., Fortin, A., Sotocinal, S. G., Ritchie, J. et al., “Pain Sensitivity and Vasopressin Analgesia Are Mediated by A Gene-Sex-Environment Interaction,” Nature Neuroscience 14, no. 12 (2011): 15691573.Google ScholarPubMed
Meloto, C. B., Bortsov, A. V., Bair, E., Helgeson, E., Ostrom, C., Smith, S. B., Dubner, R. et al., “Modification of COMT-Dependent Pain Sensitivity by Psychological Stress and Sex,” Pain 157, no. 4 (2016): 858867.CrossRefGoogle ScholarPubMed
Malfliet, A., De Pauw, R., Kregel, J., Coppieters, I., Meeus, M., Roussel, N., Danneels, L., Cagnie, B., and Nijs, J., “Gender Differences in the Association of Brain Gray Matter and Pain-Related Psychosocial Characteristics,” Pain Physician 22, no. 3 (2019): E191E203.CrossRefGoogle ScholarPubMed
Luthar, S. S., Cicchetti, D., and Becker, B., “The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work,” Child Development 71, no. 3 (2000): 543562.Google ScholarPubMed
Sturgeon, J. A. and Zautra, A. J., “Resilience: A New Paradigm for Adaptation to Chronic Pain,” Current Pain and Headache Reports 14, no. 2 (2010): 105112.Google ScholarPubMed
Hodes, G. E. and Epperson, C. N., “Sex Differences in Vulnerability and Resilience to Stress Across the Life Span,” Biological Psychiatry 86, no. 6 (2019): 421432; I. P. Fallon, M. K. Tanner, B. N. Greenwood, and M. V. Baratta, “Sex Differences in Resilience: Experiential Factors and Their Mechanisms,” European Journal of Neuroscience 52, no. 1 (2020): 2530–2547.CrossRefGoogle ScholarPubMed
You, B., Wen, H., and Jackson, T., “Identifying Resting State Differences Salient for Resilience to Chronic Pain Based on Machine Learning Multivariate Pattern Analysis,” Psychophysiology (2021): e13921, doi: 10.1111/psyp.13921. Epub ahead of print.Google ScholarPubMed
Giannantoni, A., Gubbiotti, M., Balzarro, M., and Rubilotta, E., “Resilience in the Face of Pelvic Pain: A Pilot Study in Males and Females Affected by Urologic Chronic Pelvic Pain,” Neurourology Urodynamics 40, no. 4 (2021): 10111020.CrossRefGoogle ScholarPubMed
Elliott, A. M., Burton, C. D., and Hannaford, P. C., “Resilience Does Matter: Evidence from a 10-Year Cohort Record Linkage Study,” BMJ Open 4, no. 1 (2014): e003917, doi: 10.1136/bmjopen-2013-003917.Google ScholarPubMed
Rovner, G. S., Sunnerhagen, K. S., Björkdahl, A., Gedle, B., Börsbo, B., Johansson, F., and Gillanders, D., “Chronic Pain and Sex-Differences; Women Accept and Move, While Men Feel Blue,” PLoS One 12, no. 4 (2017): e0175737, doi: 10.1371/journal.pone.0175737.CrossRefGoogle ScholarPubMed
Bandura, A., “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” Psychological Review 84, no. 2 (1977): 191215.CrossRefGoogle Scholar
Miller, C. and Newton, S. E., “Pain Perception and Expression: The Influence of Gender, Personal Self-Efficacy, and Lifespan Socialization,” Pain Management Nursing 7, no. 4 (2006): 148152.Google ScholarPubMed
Jackson, T., Iezzi, T., Gunderson, J., Nagasaka, T., and Fritch, A., “Gender Differences in Pain Perception: The Mediating Role of Self-Efficacy Beliefs,” Sex Roles 47, no. 11 (2002): 561–68.CrossRefGoogle Scholar
Kaasbøll, J., Ranøyen, I., Nilsen, W., Lydersen, S., and Indredavik, M. S., “Associations Between Parental Chronic Pain and Self-Esteem, Social Competence, and Family Cohesion in Adolescent Girls and Boys—Family Linkage Data from the HUNT Study,” BMC Public Health 15 (2015): art. no. 817, doi: 10.1186/s12889-015-2164-9.CrossRefGoogle ScholarPubMed
Wilson, A. C., Holley, A. L., Stone, A., Fales, J. L., and Palermo, T. M., “Pain, Physical, and Psychosocial Functioning in Adolescents at Risk for Developing Chronic Pain: A Longitudinal Case-Control Study,” The Journal of Pain 21, no. 3-4 (2020): 418429.CrossRefGoogle Scholar
Resnik, D. B., Rehm, M., and Minard, R. B., “The Undertreatment of Pain: Scientific, Clinical, Cultural, and Philosophical Factors,” Medicine, Health Care and Philosophy 4, no. 3 (2001): 277288.CrossRefGoogle ScholarPubMed
Van Zee, A., “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” American Journal of Public Health 99, no. 2 (2009): 221227.Google ScholarPubMed
Bernard, S. A., Chelminski, P. R., Ives, T. J., and Ranapurwala, S. I., “Management of Pain in the United States—A Brief History and Implications for the Opioid Epidemic,” Health Services Insights 11 (2018), doi: 10.1177/1178632918819440. See also C. I. Campbell, C. Weisner, L. Leresche, G. T. Ray, K. Saunders, M. D. Sullivan, C. J. Banta-Green et al., “Age and Gender Trends in Long-Term Opioid Analgesic Use for Noncancer Pain,” American Journal of Public Health 100, no. 12 (2010): 2541–2547.Google ScholarPubMed
Portenoy, R. K. and Foley, K. M., “Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases,” Pain 25, no. 2 (1986): 171186.Google ScholarPubMed
A review of 25 studies of opioid addiction for non-malignant chronic pain found rates ranged from 0 – 50%. Højsted, J. and Sjøgren, P., “Addiction to Opioids in Chronic Pain Patients: A Literature Review,” European Journal of Pain 11, no. 5 (2007): 490518.Google ScholarPubMed
McCauley, J. L., Hyer, J. M., Ramakrishnan, V. R., Leite, R., Melvin, C. L., Fillingim, R. B., Frick, C., and Brady, K. T., “Dental Opioid Prescribing and Multiple Opioid Prescriptions Among Dental Patients: Administrative Data from the South Carolina Prescription Drug Monitoring Program,” Journal of the American Dental Association 147, no. 7 (2016): 537544; see also S. S. De Rossi, Dentistry and the Opioid Epidemic, Medscape, August 26, 2016), available at <https://www.medscape.com/viewarticle/867751> (last visited July 25, 2022).Google ScholarPubMed
Denisco, R. A., Chandler, R. K., and Compton, W. M., “Addressing the Intersecting Problems of Opioid Misuse and Chronic Pain Treatment,” Experimental and Clinical Psychopharmacology 16, no. 5 (2008): 417428.Google ScholarPubMed
Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health: National Findings, NSDUH Series H-32, DHHS Publication No SMA 07-4293 (Rockville, MD: Office of Applied Studies, 2007): at Appendix B and C.Google Scholar
Dowell, D., Haegerich, T. M., and Chou, R., “CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016,” MMWR Recommendations and Reports 65, no. 1 (2016): 149.CrossRefGoogle Scholar
Dowell, D., Haegerich, T., and Chou, R., “No Shortcuts to Safer Opioid Prescribing,” New England Journal of Medicine 280 (2019): 22852287.Google Scholar
Human Rights Watch, “The Story of Maria Higginbotham: ‘Not Allowed to be Compassionate,’” December 18, 2018, available at <https://www.hrw.org/report/2018/12/18/not-allowed-be-compassionate/chronic-pain-overdose-crisis-and-unintended-harms-us#> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
National Center for Health Statistics, “Provisional Drug Overdose Death Counts,” available at <https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm> (last visited November 1, 2021).+(last+visited+November+1,+2021).>Google Scholar
T. Rodriguez, “Off-Label Use of Antidepressants for Chronic Pain,” Clinical Pain Advisor (October 28, 2019), available at <https://www.clinicalpainadvisor.com/home/topics/chronic-pain/off-label-use-of-antidepressants-for-chronic-pain/> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
D. M. Arbuck, “The Use of Antidepressants in Multimodal Pain Management,” Practical Pain Management (updated May 29, 2019), available at <https://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/use-antidepressants-multimodal-pain-management> (last visited November 1, 2021).+(last+visited+November+1,+2021).>Google Scholar
U.S. Department of Health and Human Services, Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations (May 2019), available at <https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Agency for Healthcare Research and Quality, Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review, AHRQ Publication No. 18-EHC013-EF (June 2018), available at <https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/nonpharma-chronic-pain-cer-209.pdf> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Alspach, J. G., “Because Women’s Lives Matter, We Need to Eliminate Gender Bias,” Critical Care Nurse 37, no. 2 (2017): 1018. (See also for implicit bias and recommendations).Google Scholar
Two books, Unwell Women and Doing Harm, released in the last decade provide detailed accounts of these broader disparities in women’s treatment for a variety of health conditions. See Cleghorn, E., Unwell Women: Misdiagnosis and Myth in a Man-made World (New York: Dutton, 2021); M. Dusenbery, Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick (New York: HarperOne, 2018).Google Scholar
Ballweg, M. L., “Impact of Endometriosis on Women’s Health: Comparative Historical Data Show that the Earlier the Onset, the More Severe the Disease,” Best Practice and Research Clinical Obstetrics and Gynaecology 18, no. 2 (2004): 201–18; R. Greene, P. Stratton, S. D. Cleary, M. L. Ballweg, and N. Sinaii, “Diagnostic Experience Among 4,334 Women Reporting surgically Diagnosed Endometriosis,” Fertility and Sterility 91, no. 1 (2009): 32–39.CrossRefGoogle ScholarPubMed
However, men with chronic prostatitis may need to see multiple physicians before finding one that can adequately treat their pain. M. P. O’Leary, “Treating Prostatitis: Any Cause for Optimism?” Harvard Medical School Blog (November 3, 2009), available at <https://www.health.harvard.edu/blog/treating-prostatitis-any-cause-for-optimism-20091103211> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Newman-Toker, D. E., Moy, E., Valente, E., Coffey, R., and Hines, A. L., “Missed Diagnosis of Stroke in the Emergency Department: A Cross-Sectional Analysis of a Large Population-Based Sample,” Diagnosis 1, no. 2 (2014): 155166.CrossRefGoogle ScholarPubMed
Maserejian, N. N., Link, C. L., Lutfey, K. L., Marceau, L. D., and McKinlay, J. B., “Disparities in Physicians’ Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment,” Journal of Women’s Health 18, no. 10 (2009): 16611667.Google ScholarPubMed
Michael, G. E., Sporer, K. A., and Youngblood, G. M., “Women Are Less Likely than Men to Receive Prehospital Analgesia for Isolated Extremity Injuries,” American Journal of Emergency Medicine 25, no. 8 (2007): 901906.CrossRefGoogle ScholarPubMed
Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., Sease, K. L. et al., “Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain,” Academic Emergency Medicine 15, no. 5 (2008): 414418.Google ScholarPubMed
Heins, J. K., Heins, A., Grammas, M., Costello, M., Huang, K., and Mishra, S., “Disparities in Analgesia and Opioid Prescribing Practices for Patients with Musculoskeletal Pain in the Emergency Department,” Journal of Emergency Nursing 32, no. 3 (2006): 219224.Google ScholarPubMed
Safdar, B., Heins, A., Homel, P., Miner, J., Neighbor, M., DeSandre, P., and Todd, K. H., “Impact of Physician and Patient Gender on Pain Management in the Emergency Department – A Multicenter Study,” Pain Medicine 10, no. 2 (2009): 364372.Google ScholarPubMed
Hirsh, A. T., Hollingshead, N. A., Bair, M. J., Matthias, M. S., Wu, J., and Kroenke, K., “The Influence of Patient’s Sex, Race and Depression on Clinician Pain Treatment Decisions,” European Journal of Pain 17, no. 10 (2013): 15691579.Google ScholarPubMed
Hirsh, A. T., Hollingshead, N. A., Matthias, M. S., Bair, M. J., and Kroenke, K., “The Influence of Patient Sex, Provider Sex, and Sexist Attitudes on Pain Treatment Decisions,” The Journal of Pain 15, no. 5 (2014): 551559.Google ScholarPubMed
Denisco, R. A., Chandler, R. K., and Compton, W. M., “Addressing the Intersecting Problems of Opioid Misuse and Chronic Pain Treatment,” Experimental and Clinical Psychopharmacology 16, no. 5 (2008): 417428.Google ScholarPubMed
Campbell, C. I., Weisner, C., LeResche, L., Ray, G. T., Saunders, K., Sullivan, M. D., Banta-Green, C. J. et al., “Age and Sex Trends in Long-Term Opioid Analgesic Use for Non-Cancer Pain,” American Journal of Public Health 100, no. 12 (2010): 25412547.Google Scholar
National Center for Cultural Competence, Two Types of Bias, available at <https://nccc.georgetown.edu/bias/module-3/1.php> (last visited October 15, 2021).+(last+visited+October+15,+2021).>Google Scholar
Wesolowicz, D. M., Clark, J. F., Boissoneault, J., and Robinson, M. E., “The Roles of Gender and Profession on Gender Role Expectations of Pain in Health Care Professionals,” Journal of Pain Research 11 (2018): 11211128.Google ScholarPubMed
Hirsh, A. T., Jensen, M. P., and Robinson, M. E., “Evaluation of Nurses’ Self-Insight into Their Pain Assessment and Treatment Decisions,” The Journal of Pain 11, no. 5 (2010): 454461.Google ScholarPubMed
Hollingshead, N. A., Matthias, M. S., Bair, M. J., and Hirsh, A. T., “Impact of Race and Sex on Pain Management by Medical Trainees: A Mixed Methods Pilot Study of Decision Making and Awareness of Influence,” Pain Medicine 16, no. 2 (2015): 280–90.Google ScholarPubMed
Rice, K., Ryu, J. E., Whitehead, C., Katz, J., and Webster, F., “Medical Trainees’ Experiences of Treating People with Chronic Pain: A Lost Opportunity for Medical Education,” Academic Medicine 93, no. 5 (2018): 775780.Google ScholarPubMed
Schäfer, G., Prkachin, K. M., Kasewater, K. A., and de, A. C. Williams, C., “Health Care Providers’ Judgments in Chronic Pain: The Influence of Gender and Trustworthiness,” Pain 157, no. 8 (2016): 1618–25.Google ScholarPubMed
Hoffmann and Tarzian, supra note 1.Google Scholar
Samulowitz, A., Gremyr, I., Eriksson, E., and Hensing, G., “‘Brave Men’ and ‘Emotional Women’: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain,” Pain Research and Management 25 (2018): art. no. 6358624, available at <https://doi.org/10.1155/2018/6358624> (last visited July 25, 2022).Google Scholar
Leeds, F. S., Smmer, E. M., Andrasik, W. J., Atwa, K. M., and Crawford, T. N., “A Patient-Narrative Video Approach to Teaching Fibromyalgia,” Journal of Medical Education and Curricular Development 7 (2020): art. no. 2382120520947068, doi:10.1177/2382120520947068 (“Although fibromyalgia is one of the most common and clinically important rheumatologic entities, physicians frequently report that their training fails to prepare them to manage this disease. Many medical schools devote insufficient time and attention to the subject of fibromyalgia, resulting in training gaps that can manifest as failures of both knowledge and empathy.”)Google ScholarPubMed
Loeser, J. D. and Schatman, M. E., “Chronic Pain Management in Medical Education: A Disastrous Omission,” Postgraduate Medicine, 129, no. 3 (2017): 332335.CrossRefGoogle ScholarPubMed
Id. See also Shipton, E. E., Bate, F., Garrick, R., Steketee, C., Shipton, E. A., and Visser, E. J., “Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally,” Pain and Therapy 7, no. 2 (2018): 139161.CrossRefGoogle ScholarPubMed
M. Mallampalli, “A Call to Action for Helping Women in Chronic Pain,” Healthy Women, June 18 2020, available at <https://www.healthywomen.org/created-with-support/call-action-women-chronic-pain> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Shipton et al., supra note 160.Google Scholar
Association of American Medical Colleges, How Academic Medicine Is Addressing the Opioid Epidemic (February 2019), available at <https://www.aamc.org/system/files/d/1/63-opioids_-_how_academic_medicine_is_addressing_the_opioid_epidemic_-_20190222.pdf> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Lobo, C. P., Pfalzgraf, A. R., Giannetti, V., and Kanyongo, G., “Impact of Invalidation and Trust in Physicians on Health Outcomes in Fibromyalgia Patients,” The Primary Care Companion for CNS Disorders 16, no. 5 (2014): 10.4088/PCC.14m01664, doi: 10.4088/PCC.14m01664.Google ScholarPubMed
L. Haas, “Memoirs of Disbelief and Disease,” The New Yorker (June 4 and 11, 2018), available at <https://www.newyorker.com/magazine/2018/06/04/memoirs-of-disease-and-disbelief> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
C. Veasley, D. Clare, D. J. Clauw, T. Cowley, R. H. N. Nguyen, P. Reinecke, S. D. Vernon, and, D. A. Williams, Impact of Chronic Overlapping Pain Conditions on the Public Health and the Urgent Need for Safe and Effective Treatment: 2015 Analysis and Policy Recommendations [White paper], Chronic Pain Research Alliance (2015), The TMJ Association, available at <http://www.chronicpainresearch.org/public/CPRA_WhitePaper_2015-FINAL-Digital.pdf> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
LaChapelle, D. L., Lavoie, S., Higgins, N. C., and Hadjistavropoulos, T., “Attractiveness, Diagnostic Ambiguity, and Disability Cues Impact Perceptions of Women with Pain,” Rehabilitation Psychology 59, no. 2 (2014): 162170 (stating that when a female patient is perceived as attractive by physicians and there is not sufficient evidence for a clear diagnosis, physicians are likely to assume the patient is healthy).CrossRefGoogle ScholarPubMed
Balweg, M. L., Drury, C., Cowley, T., McCleary, K. K., and Veasley, C., Chronic Pain in Women: Neglect, Dismissal and Discrimination (Campaign to End Chronic Pain in Women, May 2010): 20, citing T. C. Olde-Hartman, L. J. Hassink-Franke, P. L. Lucassen, K. P. van Spaendonck, and C. van Weel, “Explanation and Relations. How Do General Practitioners Deal with Patients with Persistent Medically Unexplained Symptoms: A Focus Group Study,” BMC Family Practice 10 (2009): art. no. 68, doi:10.1186/1471-2296-10-68.Google Scholar
S. Gorman and J. M. Gorman, “How Should We Treat ‘Contested’ Illnesses?” Psychology Today, June 8, 2019, available at <https://www.psychologytoday.com/us/blog/denying-the-grave/201906/how-should-we-treat-contested-illnesses> (last visited July 25, 2022).+(last+visited+July+25,+2022).>Google Scholar
Hoffmann and Tarzian, supra note 1, at 16.Google Scholar
Strong, J., Mathews, T., Sussex, R., New, F., Hoey, S., and Mitchell, G., “Pain Language and Gender Differences When Describing a Past Pain Event,” Pain 145, no. 1-2 (2009): 8695.Google ScholarPubMed
Bullo, S. and Hearn, J. H., “Parallel Worlds and Personified Pain: A Mixed-Methods Analysis of Pain Metaphor Use by Women with Endometriosis,” British Journal of Health Psychology 26, no. 2 (2021): 271288.Google Scholar
Prkachin, K. M., Mass, H., and Mercer, S. R., “Effects of Exposure on Perception of Pain Expression,” Pain 111, no. 1–2 (2004): 812.Google ScholarPubMed
Bartley, E. J., Boissoneault, J., Vargovich, A. M., Wandner, L. D., Hirsh, A. T., Lok, B. C., Heft, M. W. et al., “The Influence of Health Care Professional Characteristics on Pain Management Decisions,” Pain Medicine 16, no. 1 (2015): 99111.Google ScholarPubMed
Hirsh et al., supra note 142.Google Scholar
Bartley et al., supra note 174,citing, C. S. Weisse, Sorum, P. C., and Dominguez, R. E., “The Influence of Gender and Race on Physicians’ Pain Management Decisions,” The Journal of Pain 4, no. 9 (2003): 505510; C. S. Weisse, P. C. Sorum, K. N. Sanders, and B. Y. Syat, “Do Gender and Race Affect Decisions About Pain Management?” Journal of General Internal Medicine 16, no. 4 (2001): 211–17; and Safdar et al., supra note 139.Google Scholar
Safdar et al., supra note 139. Other significant “univariate associations” with opioid administration included: “patient age, arrival pain score, average pain score, time to triage, number of pain assessments and whether follow-up plans were noted in the chart.”Google Scholar
Safdar et al., supra note 139.Google Scholar
Dwass, E., Diagnosis Female: How Medical Bias Endangers Women’s Health (Lanham, MD: Rowman and Littlefield, 2019): 20, citing Paula Johnson’s 2017 TED talk “When Does Medicine Leave Women Behind.”Google Scholar