The Gender Bias in Pain Medicine: What Every Woman Needs to Know.
Women, does it sometimes feel like medicine has been designed for someone else’s body?
Both groundbreaking discoveries and glaring oversights mark the history of medical research.
One of the most significant oversights was excluding women from clinical trials.
Before 1993, the National Institutes of Health (NIH), the US’s largest public funder of medical research, did not require women to be included in its trials.
History of Women’s Participation in Clinical Research
orwh.od.nih.gov
This decision, informed by concerns about menstrual cycles and potential pregnancies, had far-reaching consequences. Women were excluded from many studies.
A Deeply Flawed Assumption
That assumption, as it turns out, was deeply flawed.
However, the scientific community is now working to build a better understanding of why women experience pain differently (than men) and what that means for treatment.
“It is by standing up for the rights of girls and women that we truly measure up as men.” — Desmond Tutu, South African cleric and theologian.
Let’s look at some theories about why some pain medications fall short in women.
Pain Medicine and Women
Could sex-related differences in pain medicine effectiveness be secondary to women’s more active immune systems?
After all, women often need higher doses than men and tend to use pain medicine more frequently.
Or maybe it is sex hormones?
For example, estrogen is a hormone that is more abundant in women. Estrogen has several effects, including the following:
- Slows stomach emptying
- Increase body-fat ratio
While those might be reasons women metabolize drugs differently than men, my literature review yielded no compelling evidence to support any given theory.
Anti-inflammatory Drugs and Response by Sex
In my oncology practice, I see subtle differences in pain medicine use by sex.
For instance, many of my patients take non-steroidal anti-inflammatory drugs (NSAIDs) for mild to moderate pain.
I wondered about my perception that the women seemed to need more pain medicine.
However, I could find no compelling data to support my anecdotal observation.
Mixed results
Some studies indicate a stronger analgesic effect in men, particularly in electrically induced pain models, while others show no significant difference.
The Gender Bias in Pain Medicine: Side Effect Differences
Unfortunately, many clinical trials evaluating pain medications excluded women.
Still, I could find high-level evidence of sex differences for pain medicines, at least when it comes to effectiveness (more about toxicity in a bit).
I discovered a 2020 study documenting differences in how women break 86 drugs down differently (than men).
Women metabolized virtually all of the tested drugs more slowly, leading to higher blood concentrations.
Sex differences in pharmacokinetics predict adverse drug reactions in women.
bsd.biomedcentral.com
The result? More drug-related complications in women, including:
- Nausea
- Hallucinations
- Headaches
- Seizures
Did you know that between 1997 and 2001, the Food and Drug Administration pulled 10 drugs from the market?
Here’s the thing: Eight withdrawals were related to greater health risks among women.
My Thoughts – The Gender Bias in Pain Medicine
I must acknowledge that clinical bias may play a role in sex differences.
Studies have shown that women are sometimes less likely to be prescribed pain medication, even when reporting similar levels of pain as men.
This disparity can contribute to the perception that pain medications are less effective for women.
Women need to be good advocates for themselves regarding pain medicines.
And we have to work harder better to understand sex-related differences in pain medicine effectiveness and toxicity.
What has been your experience?
Thank you for reading “The Gender Bias in Pain Medicine.” Enjoyed the piece? Please sign up to follow me.
