In a recent study, researchers found that a patient’s pain responses may be perceived differently by others based on their gender.
The study was published in The Journal of Pain, with the co-author being Elizabeth Losin, assistant professor of psychology and director of the Social and Cultural Neuroscience lab at the University of Miami. A previous study showed that men are seen as more stoic and women as more emotional in expression of pain.
In the first of two experiments in the study, 50 participants viewed videos of male and female patients complaining of shoulder pain as they performed a series of range of motion exercises using their injured and uninjured shoulders. These videos came from a database that contains videos of actual shoulder injury patients, each with a different level of pain, as well as the patients’ self-reported discomfort levels on shoulder movement.
According to Prof Losin, this study is more applicable to patients in a clinical setting.
“One of the advantages of using these videos of patients who are actually experiencing pain from an injury is that we have the patients’ ratings of their own pain,” she explained. “We had a ground truth to work with, which we can’t have if it’s a stimulus with an actor pretending to be in pain.”
The patients’ facial expressions were also analysed through the Facial Action Coding System (FACS)—a system for describing all visible facial movements. The researchers created an objective score of the intensity of the patients’ pain facial expressions derived from the FACS values, providing a second ground truth.
The study participants were asked to gauge the amount of pain they thought the patients in the videos experienced on a scale from zero, labeled as “absolutely no pain,” to 100, labeled as “worst pain possible.”
For the second experiment, the first experiment was replicated with 200 participants, who were asked to complete the Gender Role Expectation of Pain questionnaire, which measures gender-related stereotypes about pain sensitivity, the endurance of pain, and willingness to report pain.
The participants also reported the amount of medication and psychotherapy they would prescribe to each patient, and which of these they believed be a more effective treatment for that patient.
The researchers analysed the participants’ perceptions relative to the two ground truth pain measures, Prof Losin explained. That is because bias could be defined as different ratings for male and female patients despite the same level of responses.
Overall, the study found that female patients were perceived to be in less pain than the male patients who reported, and exhibited, the same intensity of pain. Additional analyses using participants’ responses to the questionnaire about gender-related pain stereotypes allowed researchers to conclude that these perceptions were partially explained by these stereotypes.
“If the stereotype is to think women are more expressive than men, perhaps ‘overly’ expressive, then the tendency will be to discount women’s pain behaviors,” Prof Losin said. “The flip side of this stereotype is that men are perceived to be stoic, so when a man makes an intense pain facial expression, you think, ‘Oh my, he must be dying!’ The result of this gender stereotype about pain expression is that each unit of increased pain expression from a man is thought to represent a higher increase in his pain experience than that same increase in pain expression by a woman.”
Additionally, the researchers found that psychotherapy was also selected over medication for a higher proportion of female than male patients. The participants’ gender did not influence pain estimation, with both male and female participants perceiving women’s pain to be less intense.
Prof Losin said the study was motivated by literature showing that women received less treatment for pain and waited longer.
“There’s a pretty wide literature showing demographic differences in pain report, the prevalence of clinical pain conditions, and then also a demographic difference in pain treatments,” Losin pointed out. “These differences manifest as disparities because it seems that some people are getting undertreated for their pain based on their demographics.”
Moving forward, Prof Losin and her fellow researchers hope this study is a step in identifying and addressing gender disparities in health care.
Prof Losin said that even medically trained people are subject to such biases. “Critically, our results demonstrate that these gender biases are not necessarily accurate. Women are not necessarily more expressive than men, and thus their pain expression should not be discounted.”
Source: Medical Xpress
Journal information: Lanlan Zhang et al, Gender Biases in Estimation of Others’ Pain, The Journal of Pain (2021). DOI: 10.1016/j.jpain.2021.03.001
