7 Things We Learned About the Gender Pain Gap While Building a Neurotechnology Company
As co-founders of a neurotechnology company focused on women’s health, Samphire Neuroscience, Alex Cook and I embarked on a mission to revolutionize mood and pain management, and improve the lives of individuals experiencing neglected sex-specific conditions. Throughout our journey, we went from knowing a little bit about it, to seeing the gender pain gap impacting most social interactions around us. Here, we shed light on the critical lessons we learned about this pervasive issue and its implications for healthcare and building technology solutions in the 21st century.
Before we begin — what is the gender pain gap?
The gender pain gap refers to the differences in the treatment, research, diagnosis, and belief surrounding pain experienced by men and women (Tarzian and Hoffmann, 2006). This gap reflects a critical health disparity that has serious implications for women worldwide. Notably, evidence indicates that women experience pain more frequently, more intensely, and for longer durations compared to men (Bartley and Fillingim, 2013). Despite this, their pain is often under-treated or dismissed, partly due to persistent biases and misconceptions (Hoffmann and Tarzian, 2001). We’ll tell you all about it.
Our firsthand experience developing a novel medical neurotechnology solution for women’s PMS and menstrual pain exposed us to countless stories of women whose pain was dismissed, overlooked, or undermined by healthcare providers. The impact of the gender pain gap goes beyond the immediate physical distress; it engenders a sense of frustration, helplessness, and an erosion of trust in the medical system (Unruh et al., 1996). It is a systemic issue that demands urgent attention and rectification.
It is crucial to understand the underlying factors contributing to this gap. Implicit biases, deeply rooted in sexism and racism, often infiltrate healthcare practices, leading to disparities in pain management (Sabin & Greenwald, 2012), even when patients present with identical symptoms. The tendency to view women’s pain as subjective, emotional, or exaggerated perpetuates a cycle of inadequate treatment and insufficient recognition of their suffering. Moreover, the intersectionality of race and gender further exacerbates this problem, with women of colour encountering additional obstacles in having their pain acknowledged (Bartley & Fillingim, 2013).
While the gender pain gap has been acknowledged to some extent, by speaking at public events, to patients, journalists, investors and doctors, we found that too little is known about its intricate nuances and far-reaching consequences. It is imperative to delve deeper into the underlying causes, societal norms, and cultural variations that influence pain perception, assessment, and management. Only through comprehensive understanding can we pave the way for effective solutions and bridge this painful divide.
In the forthcoming sections, we will share 7 pivotal lessons we learned about the gender pain gap during our journey in building a neurotechnology company, Samphire Neuroscience. By highlighting these insights, we hope to raise awareness, ignite conversations, and inspire meaningful change in how we approach pain management and advocate for equitable care for all.
- Women’s pain is unique, and neglected
While it may be tempting to say that when one speaks of the experiences of pain, it encompasses the experiences of men and women alike, that is simply not the case. Hormones and gender-specific genetic factors can influence pain sensitivity, with studies suggesting that oestrogens modulate pain perception in women (Aloisi et al., 2010). Psychosocial factors, like societal expectations and stereotypes around pain tolerance, can also shape both self-reported pain levels and healthcare providers’ responses to them (Bernardes et al., 2013).
Pain in women is often stigmatized and trivialized, leading to undertreatment or misdiagnosis. Women are more likely than men to be prescribed sedatives rather than pain medication, and they are often perceived as “overreacting” or being “too emotional” (Hoffmann and Tarzian, 2001). This disparity extends to research, with women being underrepresented in clinical trials on pain and pain management (Mogil and Chanda, 2005).
In our experiences learning from women experiencing PMS and menstrual pain over the last couple of years, whether linked to diagnoses of PMDD, endometriosis, uterine fibroids or otherwise, women tend to disproportionately play down their pain, avoid bringing up its impact on their everyday functioning unless specifically asked about it, and tend to look for solutions by themselves, often in isolation from their partners, families and –often– doctors, who they think don’t hear their concerns.
2. Intersectionality: Race and Gender
The second crucial lesson we learned is the intersectionality of race and gender in the context of the gender pain gap. Intersectionality, a concept coined by Kimberlé Crenshaw in 1989, is crucial to understanding health disparities. It refers to the interconnected nature of social categorizations such as race, class, and gender, which can result in overlapping and interdependent systems of discrimination or disadvantage. In the context of the gender pain gap, intersectionality further complicates the picture, as race and ethnicity can compound the challenges faced by women in pain management.
Studies have revealed that women of colour face even greater disparities in pain management compared to white women (Hoffman et al., 2016). Black and Hispanic patients, for instance, are often less likely to receive adequate pain relief, including analgesics and more powerful opiates (Tamayo-Sarver et al., 2003). These disparities can be attributed to false beliefs and biases surrounding the pain experiences of people of colour. Historical factors and systemic racism have perpetuated the perception that Black women, in particular, feel less pain than their white counterparts. Understanding and addressing the impact of race on pain management is essential to achieve equitable care for all individuals.
One stark example lies in the differential prevalence and treatment of conditions like uterine fibroids, which are benign tumors that develop within the muscular wall of the uterus. Fibroids are more common and tend to be larger and more symptomatic in Black women compared to any other group. However, Black women are unlikely to be offered less invasive treatments for fibroids and are more likely to undergo hysterectomies when compared to women of any other group with the same diagnosis, a disparity not fully explained by socioeconomic status or insurance coverage (Marsh et al., 2009).
In addition to the physical burden, there’s a psychological toll as well. Black women are frequently confronted with medical racism, where their symptoms are minimized or ignored by healthcare providers, further exacerbating health disparities (Hoffman et al., 2016). The above is something that we’ve spent hours discussing with Ashlee and Eddwina, founders of Health in HER Hue, who offer access to culturally-sensitive providers for women in the US in order to reduce the prevalence of racially biased treatments being prescribed.
Similarly, research shows that racial and ethnic minorities, particularly Black and Hispanic women, are less likely to receive adequate pain management compared to white patients, even when controlling for age, gender, and pain intensity (Green et al., 2003). This gap highlights a deeply entrenched issue of racial bias in healthcare that goes beyond gender alone.
Through our journey, we have come to believe that patient education and empowerment, particularly in under-resourced communities, is a critical force that can help all women advocate for their health needs effectively. This is because in a system that still neglects women’s needs as a whole, and those of women of colour even more, the onus is on doctors, the medical system, politicians, regulators and medical educators to do better. However, we cannot lose more women to these inefficiencies in the healthcare system while we wait for it to get better so, for the time being, we have come to believe that creating resources and access to information about their health can enable women to not be treated as “default ignorant” by doctors, shake up the knowledge of their own doctors, and avoid the detrimental impacts of biased treatment option offerings.
3. Some Conditions Affect Women Disproportionately
The third lesson we learned centers around the fact that certain conditions disproportionately affect women, contributing to the gender pain gap. Conditions like migraines, fibromyalgia and endometriosis predominantly affect women, yet their diagnosis and treatment often face delays or dismissal (Nnoaham, 2011).
While there are, of course, also conditions that disproportionately affect men, a recent research analysis by Arthur Mirin, a US-based applied mathematician, was quoted by Sarah Temkin, associate director for clinical research at the NIH Office of Research on Women’s Health in Bethesda, Maryland, that it “demonstrates that the funding of research for women is not aligned with burdens of disease”.
This is not a drop in the ocean study. Another analysis focused on cancer funding, and showed that gynaecological cancers receive much less support than do other cancers when accounting for lethality (years of life lost for each new diagnosis). In a selection of 19 cancers, ovarian cancer ranks 5th for lethality, but 12th in terms of its funding-to-lethality ratio. Similar observations were seen for cervical cancer. Shockingly, for many gynaecological cancers, which disproportionately affect women, the ratio of funding to mortality dropped during the 11-year period. This means that, proportionally to lives lost to gynaecological cancers, the funding for their treatment and R&D decreased (Nature, 2023). This is striking, as in a world where we expect increasingly more governmental funding decisions to be proportional to lost quality of life years (or QALYs), the playbook seems to not work when it comes to women’s health needs. This research was published in Nature and is detailed out with interactive charts here.
And, while data on the disproportionate burden of women’s health conditions continues to emerge, at the time of writing we know that women with these conditions still often encounter skepticism or disbelief regarding their pain experiences, including in clinical settings, resulting in inadequate care. Understanding the unique challenges faced by women with these conditions is essential for developing targeted interventions and improving their pain management outcomes.
4. Individual Variation in Pain Perception
Our fourth insight relates to the inherent variability in pain perception among individuals. As we have navigated the world of pain management, it has become increasingly clear that pain, by its very nature, is a deeply subjective experience, informed by an array of genetic, psychological, and environmental factors (Mogil et al., 2019). To further complicate matters, one’s cultural background, past experiences with pain, mental health status, and even personal belief systems can all play a role in shaping pain perception and expression (Edwards et al., 2019).
It is vital, therefore, that healthcare providers recognize and respect these individual differences when evaluating and treating pain. While standardized pain assessment scales can provide valuable initial insights, they can fall short in capturing the rich complexity of an individual’s pain experience. Patients’ self-reported experiences remain the gold standard for assessing pain, but even these can be influenced by factors such as fear of stigma, anxiety about being perceived as weak, or concern about the potential implications of their pain on their health prognosis (Asmundson et al., 2019).
Healthcare professionals should be aware that individuals can have vastly different pain thresholds and tolerance levels. Furthermore, the ways individuals articulate their pain can vary widely, from stoic endurance to overt expressions of distress. It’s crucial to understand that none of these responses are more or less valid than another. The stoicism of one patient does not necessarily reflect a lesser degree of pain than the vocal distress of another. Rather, these are expressions of personal coping mechanisms, cultural norms, or learned behaviors, none of which should undermine the legitimacy of their pain experience (Bernardes et al., 2013). This is especially common and true for women, who have systemically underplayed their experiences of pain.
One aspect stuck out to us when we were running our initial product testing. In order to assess users’ satisfaction, we asked them to fill out standard clinical questionnaires around pain and cognitive PMS symptoms, and to expand on those over short-form video. However, what we didn’t expect was that when we looked at the rating scales, we could see reductions in pain scores and improvements in mood; but the only thing that women kept going on and on about in the videos was what they could actually do -and get done- because they no longer struggled with PMS or menstrual cramps. Many of them spoke about this being the first time they could go to the gym while on their period, or follow-through with social plans with their friends, or actually show up at work feeling like themselves. This showed to us that while clinical scales are, of course, necessary, when it comes to women’s pain and mood experiences, people are still uncertain of what’s normal, and women, especially, will downplay their pain as average, which hides their struggle.
Given these intricate variations, personalised approaches to pain understanding should become indispensable in bridging the gender pain gap. Healthcare providers should engage with their patients in open, non-judgmental dialogues about their pain experiences, striving to understand the multifaceted influences on their pain perception and expression. This approach fosters an environment of trust and mutual respect, essential for successful pain management (Makhlouf et al., 2019). The same holds true for friends and, when appropriate, colleagues and managers, who can help us understand that pain developed as a signal for our bodies to pay attention to, and therefore pain, in its any shape or form, is never normal.
5. Understanding and Navigating Cultural Variation in Pain Management Approaches
Our fifth discovery concerns the importance of acknowledging and navigating the cultural variation in pain management approaches. Throughout our endeavours in the field of neurotechnology, we have encountered countless instances of how cultural norms and beliefs shape the narrative around pain expression, coping mechanisms, and the pursuit of healthcare (Green et al., 2003).
Pain expression can be an immensely cultural phenomenon. In some cultures, stoicism is a virtue, and pain is downplayed or internalized. These individuals might under-report their pain levels or deny the severity of their symptoms, complicating accurate pain assessment (Bernardes et al., 2013). Conversely, other cultures may favour more overt expressions of discomfort and distress, leading to different interpretations of their pain experience by healthcare professionals.
For instance, let me illustrate with my personal background. I grew up in Lithuania, where historically, minimizing one’s pain was a common response to avoid drawing attention to oneself. Expressing intense emotions or pain could be seen as a sign of weakness and an attempt to seek attention, both of which contradicted the desired understated behavior in life. However, during my time living in the United States, I observed a notable difference in how people approached seeking attention. It was more acceptable and even regarded as a strength. Although this observation may not apply universally, it did indicate that sharing personal and vulnerable experiences was less stigmatised, at least at a surface level.
Cultural beliefs also impact individuals’ healthcare-seeking behaviors and their engagement with different treatment modalities. For example, some cultures might lean towards complementary and alternative medicine, such as acupuncture, herbal remedies, or mind-body therapies, in managing pain (Zhang et al., 2021). Others might fully embrace popping a painkiller at the tiniest sight of inconvenience. Therefore, understanding these cultural preferences is critical in developing an effective and patient-centered pain management plan.
Cultural sensitivity and humility in pain assessment and management are essential. This includes being open to different cultural expressions of pain, acknowledging the influence of cultural beliefs on pain management preferences, and understanding the role of culture in shaping patient-provider interactions.
Developing and practicing cultural competence is an ongoing process, requiring continuous learning and adaptation. The goal is to ensure that healthcare providers can effectively communicate with and understand their patients from various cultural backgrounds. In doing so, we can promote equitable care, improve patient satisfaction, and ultimately narrow the gender pain gap.
As a neurotechnology company dedicated to advancing women’s health, we continually strive to understand the diverse cultural contexts in which pain is experienced and managed, aiming to create technology solutions that are not only effective but also culturally sensitive and inclusive.
6. Addressing the Absence of Sex-Specific Information in Clinical Trial Endpoints
Another significant insight we gained pertains to the conspicuous lack of sex-specific information in clinical trial endpoints, a factor that is routinely overlooked. This neglect becomes especially pertinent when considering the menstrual cycle phase in women. Hormonal fluctuations during menstrual cycles can dramatically affect pain perception and response to treatments, a fact that has been strikingly underemphasised in clinical trial design (Craft et al., 2004).
Clinical trials, the gold standard for testing medical interventions, often sidestep this crucial piece of the puzzle. They frequently fail to account for menstrual cycle phases (or perimenopausal status, when relevant), which could significantly modulate pain experiences and responses to pain medications. The repercussions of this neglect are twofold. Firstly, it produces results that may not truly represent the pain experiences and treatment responses of women. Secondly, it inadvertently perpetuates the gender pain gap by hampering our understanding of pain mechanisms in women and obstructing the development of interventions tailored to women’s pain and mental health management.
Integrating these crucial pieces of information can shed light on the unique pain experiences of women across their menstrual cycles. More importantly, it can drive the creation of more nuanced and effective pain management strategies that account for the complex interplay of biological and hormonal variations experienced by women.
The journey towards acknowledging and implementing sex-specific information in clinical trials demands a concerted effort from the broader scientific community. It requires researchers to shift their trial designs, regulatory bodies to adapt their approval criteria, and funding agencies to prioritize trials incorporating these factors. Only then can we ensure that our scientific explorations and findings are more representative, valid, and applicable to both sexes.
As a company working at the intersection of neurotechnology and women’s health, we champion the inclusion of sex-specific considerations in all stages of research and development. We firmly believe that a comprehensive understanding of sex-based differences in pain experiences and treatment responses is key to closing the gender pain gap. Our commitment to this cause is unwavering, as we strive to drive meaningful change in how pain is studied, understood, and managed.
7. Learning from the Gender Pain Gap to Innovate in Pain Management
In drawing conclusions from our lessons learned about the gender pain gap during our journey in neurotechnology, we have come to understand the pressing necessity for a paradigm shift in pain management practices. This understanding is hinged on acknowledging and proactively addressing the disparities in pain treatment, embracing the complexities of race and gender intersectionality, giving due recognition to conditions that predominantly affect women, acknowledging individual variances in pain perception, appreciating cultural nuances in pain management, and integrating sex-specific information in clinical trial endpoints. These lessons collectively illuminate a roadmap towards an equitable healthcare ecosystem for all individuals.
By deepening our understanding and boosting awareness of the gender pain gap, we can collectively advocate for revolutionary changes in healthcare systems, policies, and practices. This includes empowering women to take an active role in their pain management, enhancing healthcare provider education on biases and cultural competence, and encouraging research that delves into the intricacies of sex-based differences in pain experiences. Each of these factors will significantly contribute to bridging the gender pain gap.
As we move forward, let us envisage a future where pain is universally acknowledged, believed, and treated with the empathy and equality it deserves, free from the constraints of gender. By embracing the lessons learned from our journey, we can create a world where each individual’s pain is seen, validated, and effectively managed, crafting a brighter, more compassionate future for pain care.
Last month, CNBC International highlighted our work, among that of many others, building technology dedicated specifically for women — naming it a neglected industry worth $1 trillion.
In our company, which operates at the confluence of women’s health and neurotechnology, we are committed to addressing these disparities by tailoring our technology to cater to women’s specific needs and challenges. We are developing non-invasive, personalised medical-grade neuromodulation devices and digital therapeutics that take into account hormonal cycles, genetic predispositions, and lifestyle factors in their approach to pain and PMS symptom management. Additionally, we are consistently investing in research to ensure equitable representation of women and to validate the efficacy of our solutions across the diverse spectrum of female populations. We are dedicated to making the future of pain care equitable, personalised, and effective, one innovation at a time.
