When it comes to pain - who hurts more?

"Men vs Women on Pain- Who hurts more"?
This is the title to the article that was recently published in the TIME magazine: http://healthland.time.com/2012/01/23/men-vs-women-on-pain-who-hurts-more/

The abstract for the original study the article was basing its information on, can be accessed here:
http://www.ncbi.nlm.nih.gov/pubmed/22245360

The original study's main objective seems to be, to highlight the value of electronic medical record in driving scientific research as it provides ready access to a huge pool of patient information. Then it appears to end with the calls for "increased attention to this idea" of sex differences in pain scale ratings.

The main conclusion from the study:

- Women report higher pain intensity than men, up to one whole point higher than men in a 0-10 scale.

The explanation suggested for this:
- Hormonal differences
- Cultural/social stereotyping with men being tough especially if a female nurse is the one asking the question.

This information is well known to the clinician community. Up to 80% of the patients in the head and neck pain population are female. It is true that research has time and again evaluated the role of hormonal factors influencing pain quality and presentation in female versus male patients. Also, there are studies that validate the influence of cultural stereotyping in patient's pain ratings and hence these two explanations are valid and appropriate references.

However, I do find it is interesting how Dr. Atul Butte ends the interview with the Time magazine.

“The reasons may be biological or they may not be, but we should still be aware of the bias that patients have in reporting pain,” he says. He is hoping to continue the research by following up these results with surveys of patients’ ratings after they were treated for pain. That may help doctors to better address the real pain patients may be feeling."

Ouch...
What Dr. Butte calls as "bias that patients have" here, can very well be the context of the patient's suffering that needs to be assessed clinically. When a patient rates his or her pain, the number is an indicator of both the physical intensity of the pain and the pain's emotional impact on the quality of his or her life and overall wellness. There are numerous studies in epidemiology that analyses subjective data like pain through questionnaires that do not ENTIRELY rely on the 0-10 pain scale. For example, more and more studies look at the impact of the patient's pain on the quality of their life using concurrent assessment tools for those.


Hence calling the pain scale differences as patient "bias" is quite off the mark. It is also unfortunate that the TIME magazine ends with the statement on , "better understanding of the patient's real pain" ....


An effective clinician believes the following:
"All of the patients' pain is real...It is the clinician's work to assess, evaluate and help them manage the symptoms- physical, emotional and all. To the patients, pain validation is at least as significant as the pain cure. The true bias in pain assessment lies with the doctors and that's where the awareness needs to be.