When two contradictory facts are both true, it’s called a paradox, or a catch-22, or maybe just a quandary.
Fact 1: women’s pain isn’t taken as seriously as men’s pain, so women are less likely to be prescribed painkillers, or at least strong painkillers.
Fact 2: women are increasingly becoming addicted to painkillers which are too readily prescribed. Dr. Nora Volkow, director the National Institute on Drug Abuse (NIDA), says, “Women are more likely to have chronic pain and be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men.”
It doesn’t seem like both “facts” can be true, but they are.
I have firsthand experience that doctors treat men and women differently. My wife had excruciating back pain. Her regular physician, a woman, prescribed something like Tylenol 3, basically alternative aspirin. The pain didn’t go away. In fact, it got worse. I finally had to take her to the emergency room.
Her primary physician knew her, knew that she wasn’t an addict, but even though she was a woman herself, she didn’t take my wife’s pain seriously.
Shortly afterward, I suffered a shoulder injury to my rotator cuff. The problem wasn’t so much the pain as that I couldn’t move the arm. I had to see a specialist. In addition to setting me up with physical therapy, he prescribed a painkiller. I think it was Percocet, an opioid, an oxycodone-based medicine. Maybe it was Vicodin, a hydrocodone-based painkiller. It for sure wasn’t Tylenol or aspirin.
Sexism, right? Maybe not, or maybe not entirely. Anecdotes are good, but large-scale, wide-ranging studies are better.
A rotator cuff injury is a short-term pain. I only needed a painkiller in case the physical therapy hurt so bad that I wouldn’t want to continue with it. Back pain can be chronic, long-term pain and opioids are not a good fit for long-term pain. Even in the short term, taken as prescribed, it’s possible to become addicted.
Prescribing opioids such as oxycodone for back pain is a good way to create an addiction—or at least a dependency—because opioids lose their efficacy over time as the body builds up a tolerance for it. If that happens, you need to take more – and, over time, more and more – of the medicine just to have the same painkilling effect.
Not that my wife wanted to take them long term. She dislikes taking any medication because of the side effects, but she was in too much pain to function. But doctors, unfortunately, have to assume the worst, and may even be ordered to by their hospital or health system superiors. If a patient displays symptoms of oxycodone addiction, it reflects poorly on the doctor, too.
Another problem with taking painkillers long term is not only addiction or tolerance, but according to Kelly Servick of Science, “Morphine, oxycodone, and other opioid painkillers … can actually make you more sensitive to pain over time.” When oxycodone starts to hurt rather than help, that’s one of the symptoms of oxycodone addiction.
But there is sexism in medical treatment, starting with the belief that woman can tolerate more pain than men. Many people believe this is scientific fact, including many women. It’s almost a badge of honor that whereas the least little injury reduces a big, strong man to a whimpering mess, women if need be, can give birth to a baby while fighting off hostile forces. A 2010 episode of the Discovery show MythBusters “proved” that women have a higher pain threshold than men.
As flattering to women’s resilience as that sounds, it’s not true, according to pain researcher Roger B. Fillingim. “While most people think that women are more pain tolerant than men because of childbirth, the opposite is actually the case,” Fillingim says. The myth is partly derived from the fact that “during pregnancy, hormones are released that are believed to make women less pain sensitive.” Those hormones aren’t released on demand.
“In general, women experience higher levels of pain and are more likely to have certain pain disorders than men,” Fillingim adds. “In addition, women have greater nerve density (more nerves in a given area of the body) – which may cause women to feel pain more severely than men.” So women, unfortunately, are more susceptible to symptoms of oxycodone addiction than men.
On a 2015 Discover magazine blog post, physicist and science writer Michael Brooks agrees with Fillingim. “In some quite macabre experiments, researchers have shown that women are much more sensitive to electric shocks, muscle pain, hot and cold, and chemical pain….” Rather than being more tolerant of pain, Brooks writes, women are better at “putting on a brave face.”
That’s not just figurative. Women often put on full makeup before heading to the doctor. If you look too healthy, doctors tend to underestimate your distress.
Women don’t even suffer heart attacks the same as men. According to a 2017 Marie Claire article by Kayla Webley Adler, “A 2000 study published in the New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged mid-heart-attack … because doctors fail to recognize women’s symptoms, which can differ widely from men’s. Only one in eight female heart-attack patients report feeling chest pain, the classic warning sign in men; instead, 71 percent of women have flu-like symptoms.”
Adler adds, “Even though science tells us men and women are biologically distinct, medicine largely views us as one and the same.” In medical school, they teach using as the standard patient a 154-pound man.
Writing for Everyday Health, Tammy Worth reports that drugs affect men and women differently for a host of reasons, including metabolism, weight, stored body fat, stomach acid, hormones, etc. “Painkillers are a class of medications that have different side effects in women and men.”
But while this has been known for decades, as of January 2016, prescription medicines are still often tested on men only – if women are included, the results aren’t usually sorted by gender – in part for simplicity’s sake. Men don’t have the same monthly hormone fluctuations as women, and men don’t get pregnant, so researchers don’t have to worry about symptoms of oxycodone addiction in a newborn child.
It’s slowly getting better. “Today, around half of all human subjects in NIH-funded clinical research studies are female,” Marie Claire reports. But if you’re in pain and the nurses, orderlies, and doctors treat you like you’re whining or crazy, don’t worry about being polite. Or your makeup.
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