Wednesday, October 1, 2008

And I Thought Sex Bias in Medicine Was Waning ...

How wrong I was.

A recent study published in the Journal of Pain and Symptom Management found that female cancer patients get significantly less adequate relief of their pain than do men in a similar position. Via Reuters (and Medscape, free registration):
The researchers examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic.

Men and women did not differ significantly in terms of worst pain scores, least pain scores, or pain interference. However, average pain in the last week and "pain right now" were significantly higher in females (p<0.05).

The mean total daily dose of analgesics was significantly greater for males (130 mg morphine equivalent value) than for females (66 mg). Females were significantly less likely than males to receive prescriptions for high potency opioids (32.9% vs 51.0%).

Women were significantly more likely than men to report inadequate pain control, as indicated by scores on the Pain Management Index.
Contrary to my usual practice, I haven't tracked down the original study. So I can't speak to its strength and weaknesses. It definitely dovetails with an existing body of work that shows race and class affect patients' access to adequate pain relief.

In any event, the gender-linked differences in dosages and the percentages of patients getting the strong stuff are striking. When you consider that women 1) seek medical assistance more often than men, and 2) have the reputation of being less stoic than men (never mind what we endure in giving birth!) you'd expect women would be more likely to request and receive the most potent pain relievers. Why is the opposite true?

If you can think of a reason more plausible than sexism, let me know.


Sugarmag said...

It's interesting that you mentioned men having a reputation for being more stoic than women, I think the opposite is true. I guess It's pretty sexist to say that men are big babies. I know, I shouldn't say that.
If this study said that women received less pain relief, my guess would be that they asked for it less often for whatever reason, but the fact that women reported pain relief to be inadequate changes things.

Heather Munro Prescott said...

Did they factor in weight differences between men and women?

Sungold said...

Sugar Mag - At the very least, there are plenty of men who aren't particularly stoic - far too many to support the stereotype that they're always tougher. And yes, the key fact here is that women said their relief was still insufficient.

Heather - This is one of the problems with not having looked up the original study. :-) I think it's plausible that weight *plus* metabolic differences could explain the differences in dosage - but only *if* women then reported adequate relief. Which they didn't.

Smirking Cat said...

The pain thing is an oddity of gender stereotypes, because whereas men are stereotypically thought of as "stronger" than women, there are also a lot of jokes about men not being able to handle catching so much as a cold with any amount of grace. It seems to depend what kind of "strong" is being reduced to an all-purpose stereotype.

One factor could be the "it's all in her head" attitude that I still see in the medical field; believing that women exaggerate symptoms, so give them a pat on the head, and don't take them seriously.

Sungold said...

I know the jokes you mean. Usually, you hear them from women kvetching about their male partners who turn into total babies when they get sick.

I've personally encountered the "it's all in her head" attitude. In fact, a couple of experiences like this while I was still in my early twenties helped push me into studying the history of women's health. Even so, I'm shocked to see it apparently turn up even in cancer treatment! It's bad enough when doctors don't take fatigue and vague symptoms seriously (and this can happen to both genders but women encounter it more often). It's inexcusable when there's an obvious and highly serious cause.