Study Finds Women Receive Less Pain Treatment in Emergency Departments

New research has uncovered a stark gap in pain treatment that may feel all too familiar to many women.

Women leaving emergency departments in Israel and the US were substantially less likely than men to receive a prescription for pain medication, even where they had identical conditions or reported precisely the same pain scores.

Women receive less pain treatment in emergency departments

In one dataset of 17,576 patients, 47 percent of men left with a prescription for an analgesic medicine. For women, the figure was only 38 percent.

A team headed by psychologists Mika Guzikevits of The Hebrew University of Jerusalem and Tom Gordon-Hecker of Ben-Gurion University of the Negev, Israel, found that this pattern applied across age groups, ailments and the sex of the prescribing doctor. The findings point to a troubling sex bias in the seriousness with which women's symptoms are regarded.

"We argue that female patients receive less pain treatment than they should, which may adversely impact their health," the researchers write in their paper.

"The findings underscore the critical need to address psychological biases in healthcare settings to ensure fair and efficient treatment for all."

Recent research has exposed a worrying bias in how women’s pain is viewed more broadly. Members of the public are more inclined to believe women exaggerate their pain than men, and judge women who grimace to be in less pain than men displaying comparable expressions.

A substantial body of research has found that women who report pain may be viewed as hysterical, emotional, imagining their symptoms or even being dishonest. Such perceptions can become especially serious when they carry over into medical care.

Evidence of bias in medical pain care

Studies have shown that women who report chronic pain are more often diagnosed with a mental health condition. They also spend longer waiting for treatment in emergency rooms and are less likely to receive medication for postoperative pain management. Multiple studies, often involving surveys and virtual patients, have additionally found that practitioners tend to consider women less trustworthy and men more trustworthy when they describe pain.

To investigate real clinical outcomes, Guzikevits, Gordon-Hecker and their colleagues analysed anonymised patient information from hospitals in the US and Israel. They considered patients’ age and sex, their stated pain level and diagnosis, how frequently they attended an emergency department, and the prescriptions they received.

The data covered 21,851 patients who attended hospital because of pain, and produced striking results.

"Across these datasets, a consistent sex disparity emerges," the researchers write.

"Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients' reported pain scores and numerous patient, physician, and emergency department variables."

The team found that no factor besides the patient’s sex could account for the treatment gap. In light of the extensive evidence that women’s and men’s pain is perceived very differently, they concluded that bias explains the disparity.

Severe back pain was rated lower for female patients

In an additional experiment, the researchers gave 109 healthcare providers a case study involving a patient with severe back pain, self-rated at 9 out of 10. Every detail was the same except the patient’s sex. When the patient was a woman, participants assessed the average pain intensity as 72 out of 100, compared with 80 out of 100 when the patient was a man.

The researchers also highlighted studies that found no evidence of bias. Those studies involved patients with an observable physical cause of pain, including a broken bone or infection. By contrast, in studies where bias was detected, the reported cause was less visible, such as abdominal pain or a headache.

They suggest that computerised decision-reporting tools to support pain-relief prescribing, alongside education for health practitioners on gender bias, may help tackle the persistent problem and improve outcomes for every patient.

"Inadequate pain management is known to lead to unnecessary suffering and deleterious health effects, and also carries preventable costs for public health," the researchers write in their paper.

"The present research provides robust evidence for healthcare providers' sex bias against female patients in pain management. We identify the stereotypical perception of females' pain as one of the potential mechanisms underlying the bias.

"The findings join mounting evidence of discrimination against females in the medical system and in other areas. Undertreatment of females' pain bears immediate implications for the healthcare system and broad implications for society's attitude toward female pain."

The research was published in Proceedings of the National Academy of Sciences.