Gender Biases in Estimation of Others’ Pain

Abstract

Caregiving and other interpersonal interactions often require accurate perception of others' pain from nonverbal cues, but perceivers may be subject to systematic biases based on gender, race, and other contextual factors. Such biases could contribute to systematic under-recognition and undertreatment of pain. In 2 experiments, we studied the impact of perceived patient sex on lay perceivers' pain estimates and treatment recommendations. In Experiment 1 (N = 50), perceivers viewed facial video clips of female and male patients in chronic shoulder pain and estimated patients' pain intensity. Multi-level linear modeling revealed that perceivers under-estimated female patients' pain compared with male patients, after controlling for patients' self-reported pain and pain facial expressiveness. Experiment 2 (N = 200) replicated these findings, and additionally found that 1) perceivers' pain-related gender stereotypes, specifically beliefs about typical women's vs. men's willingness to express pain, predicted pain estimation biases; and 2) perceivers judged female patients as relatively more likely to benefit from psychotherapy, whereas male patients were judged to benefit more from pain medicine. In both experiments, the gender bias effect size was on average 2.45 points on a 0−100 pain scale. Gender biases in pain estimation may be an obstacle to effective pain care, and experimental approaches to characterizing biases, such as the one we tested here, could inform the development of interventions to reduce such biases. Perspective: This study identifies a bias towards underestimation of pain in female patients, which is related to gender stereotypes. The findings suggest caregivers' or even clinicians' pain stereotypes are a potential target for intervention.

Tapentadol and Oxycodone/Naloxone Prescribing Patterns in Primary Health Care in Catalonia, Spain: A Cross-Sectional Study

“…If we analyze the daily dose according to sex in both treatments, men took more doses than women. Although these differences were significant only in the case of oxycodone/naloxone, this is consistent with published data suggesting that elderly patients and females may suffer from bias in pain assessments or dosing 23 this could be, as it was commented before because women had less intensity of pain than men. [23][24][25] Results of a genome wide association study suggested that differences experienced by men and women in chronic pain are likely to have a genetic basis.…”

“…Although these differences were significant only in the case of oxycodone/naloxone, this is consistent with published data suggesting that elderly patients and females may suffer from bias in pain assessments or dosing 23 this could be, as it was commented before because women had less intensity of pain than men. [23][24][25] Results of a genome wide association study suggested that differences experienced by men and women in chronic pain are likely to have a genetic basis. 29 By studying the daily dose depending on the duration of treatment, in both cases an increasing length of treatment increased the daily dose used, being significant, both positive correlations.…”

“…This difference could be explained because the pain threshold in women and men is different. [23][24][25]…”

Observation of others’ threat reactions recovers memories previously shaped by firsthand experiences

“…We want to highlight that other threat recovery processes, in particular renewal (recovery threat responses within novel or dangerous context), might have contributed to the enhancement of threat responses by observation of others' US reactions. While our study was not designed to detect potential differences between male and female participants (when observing a US that is administered to a male demonstrator), we want to emphasize that differences in perceiving responses of males and females in pain (36) and identification with the demonstrator model (37) might influence observational reinstatement.…”

Exploring Access to Surgical Interventions for Hidradenitis Suppurativa: Retrospective Population-Based Analysis (Preprint)

“…suggesting that men diagnosed with HS are more likely to undergo surgery than women. This is possibly due to men generally experiencing more severe disease [28,29], underestimation and dismissal of pain in female patients [30], or a lack of surgical expertise for female care due to common lesion localization to the inguinofemoral area [28], as well as low numbers of gynecologists providing HS surgery. This emphasizes the need for improved access to care for female patients through improved surgical expertise and increased awareness surrounding perception of pain in women.…”