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A Feminist Perspective on Gender Justice in the Treatment of Chronic Pain

Laura Vearrier

Introduction: Chronic pain is a significant public health problem that disproportionately affects women. Gender justice in the management of chronic pain must involve gender-tailoring of treatment paradigms.

Gender disparities in reporting and treatment of pain: Women are more likely than men to suffer from chronic pain, including chronic pain syndromes such as fibromyalgia, migraine headaches, irritable bowel syndrome, interstitial cystitis, temporomandibular disorder, and neuropathic pain syndromes, among others. Chronic pain may be more debilitating on daily functioning in women. Women are more likely to be prescribed chronic opioid therapy for their pain and are at greater risk for polypharmacy and opioid overdose.

Gender differences in pain experience: The mechanisms underlying gender differences in pain experience and pain reporting are complex. Sex hormones, including testosterone, estrogens, and progestins, exert pronociceptive and anti-nociceptive effects through the endogenous opioid system, thereby modulating the experience of pain. Cultural norms of masculinity and feminitity influence pain reporting. Women with chronic pain are more likely than men to suffer from significant psychiatric co-morbidities, especially depression. Women and men differ in their coping mechanisms for chronic pain; women are more likely to engage in emotionalcentered coping strategies such as social support, positive statements, and relaxation. Women are also more likely to catastrophize pain, which is associated with lower ratings of self-efficacy.

A feminist perspective: Due to the endocrinologic, cultural, and social differences between women and men in the experience and reporting of chronic pain, justice requires a difference feminism approach to the treatment of pain in women. Healthcare providers should be educated on the mechanisms that modulate the experience of chronic pain and how they differ between women and men. Providers should carefully evaluate for psychiatric co-morbidities in women with chronic pain due to the higher prevalence of such disorders in this group. Holistic, or multi-modal, management of pain, while appropriate in both men and women, is of particular importance in women due to the emotional valence associated with chronic pain in women, the reliance on emotional coping methods, pain catastrophizing, and poor self-efficacy.

Conclusion: Women are more likely to experience chronic pain than men and gender justice in the treatment of chronic pain requires understanding gender differences in the experience and reporting of pain and gender-tailoring the treatment of such pain.