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June 12, 2018

Ladies, the Chronic Pain Struggle is Real. Here’s How to Fight Back.

Cindy Cooke, PhD, DNP, FNP-C, FAANP 

If you’re a woman suffering from chronic pain, you may not be getting the treatment you deserve.

More than 100 million Americans suffer from some form of chronic pain – more than cancer,
diabetes and heart disease combined. I describe it to my patients as revved up pain signals
trapped in the central nervous system, firing haphazardly  - sometimes without any injury or illness to trigger the symptoms. As you can imagine, pain signals unbridled and tangled in the brain wreak havoc on a person, and I’ve seen it happen to countless patients.

Chronic pain is our nation’s biggest health problem, and, shockingly, it affects mostly women.
We are twice as likely to have multiple sclerosis, two to three times more likely to develop
rheumatoid arthritis and four times more likely to have chronic fatigue syndrome. Between 75
and 90 percent of people with fibromyalgia are women. Actually, 75 percent of all autoimmune
disease patients are women, yet women still tend to be disproportionately undertreated or
mistreated for pain.

Why the discrepancy? Women experience more pain due to a variety of factors, including
hormones, brain chemistry and genetics. While this is concerning, as a provider, I am equally as
unsettled by the number of patients who experience a gender bias receiving treatment for
chronic pain.

This bias can play out in a variety of different ways – influencing everything from diagnoses to
medications prescribed to procedures performed. One study found doctors were more likely to
recommend knee replacement surgery to male patients with knee arthritis than to female
patients, suggesting that gender discrimination might be the reason women are three times less
likely to undergo knee replacement. Another study found that women with the same pain scores
for acute abdominal pain were significantly less likely to get any kind of pain medication and
were 20 percent less likely to get opioids specifically. The same was true for female cancer and
AIDS patients.

The real irony here is that, despite statistical validation that women are far more inclined to feel
pain, when men complain about being in pain, they are more likely to be taken seriously by their
provider, and that’s a huge problem. Already chronic pain is a silent epidemic, quietly robbing
millions of people of the quality of life they deserve. By its very nature, chronic pain is
complicated, but there are nurse practitioners and other skilled providers who are trained
specifically in chronic pain management, who easily see through bias, stigmas and stereotypes
to ensure male and female patients get the best care possible. If you suspect your provider is
discrediting your pain or not being aggressive enough in their treatment, here are five things you
can do today to advocate for better care.

  1. Speak up. It’s nearly impossible to treat chronic pain without a strong patient-provider relationship. Tell your provider exactly how you are feeling and lay out your concerns during your very first visit. Share your entire personal history and include any personal risk factors, like alcohol or drug abuse, sleep trouble or depression.
  2. Be specific. Describe your pain as best you can, using as many details as possible.Consider keeping a pain journal documenting when you feel pain and the scale of your discomfort. Even constant pain has subtle nuances that can influence treatment.
  3. Demand attention. Nurse practitioners outscore other providers in patient satisfaction, in part because we can spend more time listening and interacting with patients. If you think your provider is checking boxes instead of rolling up their sleeves to treat your problems, it may be time to find another provider.
  4. Be diligent. If it feels like your pain is being dismissed as emotional or inconsequential, say something. Too often providers are skeptical of chronic pain because it is invisible, but that does not make it any less real. Don’t get caught in a cycle of having to defend your pain or validate your concerns. Believe in yourself and find a provider who believes in you too.

Ask questions. Never accept treatment recommendations without understanding why
your provider is recommending them. Opioids like morphine, hydrocodone and naloxone
are sometimes used, but there is by no means a one-pill-fits-all solution to chronic pain,
and sometimes medication isn’t the answer. Nurse practitioners are trained in the latest
treatment options and can prescribe a plan that makes sense for you – and only you.

Chronic pain is a real problem in this country, especially for women. For those who suffer, thepain is enough of a burden without having to navigate cultural stigmas and provider bias inseeking treatment. September is National Pain Awareness Month and the perfect reminder thatwe need a cultural shift in the way society perceives and judges chronic pain, along with greatersensitivity among health care providers, especially when they treat women. Your provider canmake all the difference in your pain management – take the time to find one who will work withyou, for you, to fight back against chronic pain.