In the face of the opioid crisis, it's more important than ever to get pain management right.
But medicine often doesn't recognize that women and men are different when it comes to pain, leaving critical gaps when it comes to effectively managing chronic conditions, experts say.
“It’s not like someone’s blood pressure or temperature,” said Kim Templeton, M.D., professor of orthopedic surgery at the University of Kansas Medical Center in Kansas City.
“We could give someone medicine and the pain could be better, or it might not," Templeton told FierceHealthcare. "And if it doesn’t change, that doesn’t necessarily mean more medication is needed, it means we need to know more about the pain we’re treating.”
That gap in chronic pain management is widely reported, according to HealthyWomen, a New Jersey nonprofit health information resource for women that recently hosted a two-day summit in Maryland.
In a national survey of 1,004 women who have experienced pain for more than three months, the group found (PDF) 90% of respondents had received a diagnosis, but 62% still felt hopeless about their pain. And almost all of the respondents, 95%, said that their pain impacts their ability to live a full and active life. Nearly half of these respondents were treating their pain with opioids while others were using movement and exercise, over-the-counter medications or other prescription painkillers.
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In addition, as many as 38% of women said that their healthcare provider was not taking their pain seriously. Another 45% said their provider somewhat understands, and 17% said their provider does not understand their chronic pain at all.
"While there have been many advances in women's health over the past several years, there is still much more to be done when it comes to chronic pain in women, especially given that women are prescribed opioid pain medication more than men," Anita Gupta, a professor at Rowan University School of Medicine and senior vice president of medical strategy and government affairs at Heron Therapeutics, said in a statement. "In order to create sustainable change in pain management, it is crucial to recognize the impact of sex and gender differences in patient care so that we can define and activate best steps to manage pain in women."
Understanding the differences
Templeton said she separates the differences into two categories: sex- and gender-based medicine, noting that these differences play into every physical function in the body including kidney function, lung disease, etc.
For example, she noted that while it is hard to measure the differences, researchers do know that people in pain tend to produce less estrogen. This is a biological fact given a women’s DNA or her sex at birth. On the other hand, gender is viewing the individual based on where they fit culturally into society.
For example, in some cultures, it’s more acceptable for women than men to show pain. Studies have found men are more likely to wait to see a doctor until the pain is worse and women tend to make multiple trips to a physician before they get medication.
Also, Templeton says the healthcare industry needs to get away from the myth that pain can be measured. She wants to keep pain from becoming just a number that we point to on a chart, especially seeing as answers can vary depending on the patient and her previous experiences with pain.
Instead, Templeton believes pain needs to be looked at in terms of function and changes in function. Asking questions about movement and mobility along with other questions about what physical limitations a person has can help with that assessment.
In addition, Templeton says that women are more likely to suffer from chronic pain than men since women are more likely to suffer from chronic diseases such as osteoarthritis and fibromyalgia. Women also are more likely to have anxiety, depression and post-traumatic stress disorder, which can be sources of chronic pain.
Considering opioid alternatives
Therefore, it really comes down to asking the right questions as well as physicians knowing and making patients aware that there are other options besides opioids and pain killers—such as exercise or physical therapy—for relieving pain.
The Centers for Disease Control and Prevention reports opioid overdose deaths are higher for men than women, but the rate of overdose for women is rising faster, and they are receiving more opioid prescriptions than men. The increasing use in women is tied to both the willingness of women to visit a doctor and the higher frequency of chronic pain among middle-aged women.
While women who have been on long-term opioids cannot just stop using them, Templeton says they need to be aware of the risks—especially if a woman is of child-bearing age and becomes pregnant.
Templeton challenges physicians with ordering frequent pregnancy tests and offering contraception for these female patients to avoid pregnancy while taking opioids. For older women, physicians need to understand that opioid use may decrease lipids in their body, increasing the likelihood of injury if they fall.
Templeton tasks primary care providers with asking these questions and continuing dialogue with female patients.
“Pain is not normal and it is not okay,” Templeton said. “Women need to speak up about it.”