Women and Pain: Disparities in Treatment and Experience

Pain may be a universal human experience—especially musculoskeletal (MSK) pain, which impacts an estimated one in two Americans—but research points to significant disparities in how pain is felt and treated across different sexes and genders (USBJI, 2024). Repeated studies confirm that women are at greater risk for developing chronic back and joint pain, yet they are less likely to receive adequate treatment. Ensuring your members and employees get the care they truly need requires a deeper look into how the pain experience differs per person, and how common misconceptions and treatment paradigms can fail to fully address these discrepancies.
 

Biological roots: why pain feels different for females

When it comes to experiencing pain, a growing body of research shows that males and females are fundamentally–and biologically–different. Faced with the same injury or type of pain, females tend to experience more severe and frequent pain sensations (Bartley, 2013). Studies suggest that sex-specific traits, such as the different levels of sex hormones like estrogen and testosterone found in males versus females, underlie these disparities. With distinct effects on both the nervous and immune systems, sex hormones can influence how a person experiences pain (Bartley, 2013).

In addition to feeling pain more intensely, women are also at a higher risk for developing chronic pain conditions, including low back pain and fibromyalgia (Dawes, 2021). One literature review found that, compared to men, a higher percentage of women suffer from chronic low back pain, chronic neck pain, osteoarthritis, and rheumatoid arthritis (Overstreet, 2023). For adults aged 45 to 59, an estimated 49 percent of women suffer from low back pain, compared to just 39 percent of men—and this pattern holds up across the board for other MSK conditions (Xiang, 2016).

But biology is not the only reason why women experience a disproportionate risk and severity of MSK pain. There are other pieces to the puzzle that can amplify an individual’s pain, including an abundance of complex psychosocial factors.  

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Understanding the impact of gender norms on pain

From a social and psychological lens, many studies show how men and women cope with pain differently. For example, women are more likely to catastrophize pain (a behavior characterized by magnification and rumination on pain-related information) and exhibit lower self-efficacy (a sense of control over one's own environment and behavior) (Bartley, 2013). Not surprisingly, studies link these behaviors to both increased levels of pain, as well as deeply rooted societal and cultural beliefs about how genders should deal with pain (Bartley, 2013). These biases not only impact how men and women express pain, but also how the healthcare system may treat them.

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Unveiling gender bias in MSK care and outcomes

Unlike a distinct wound or injury, chronic MSK pain can be more or less invisible. Without clear signs of a problem, some clinicians may question both a patient’s symptoms as well as the need for serious intervention–especially if the patient is a woman. According to one research review, women with chronic pain may be perceived as hyper-emotional, dramatic, or unwilling to get better—some clinicians will go so far as to say the pain is “all in her head” (Samulowitz, 2018).

This gender bias is not only incredibly hurtful to the patient but can also prolong pain by leaving the actual problem untreated. One study evaluating risk factors for inadequate pain management (IPM) found that women were 1.6 times more likely to receive insufficient care for chronic pain due to gender-related disparities in pain perception and clinician bias (Majedi, 2019). A common example of IPM is the “psychologizing” of chronic pain, as women are less likely to be prescribed analgesics, more likely to be prescribed antidepressants, and more likely to be referred to therapy than men with comparable conditions (Moretti, 2023). The longer women have to wait to receive an accurate diagnosis and access appropriate care, the more their pain will spiral out of control and require extensive treatment to make up for lost time.

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Bridging the gender pain gap: the role of holistic MSK care

It's no secret that low-value care in the MSK space leads to increased costs, poor outcomes, and member dissatisfaction—significant problems which are even worse for your female employees and members. Despite the greater need for pain management, countless women continue to struggle to access the right clinicians who strive to dig deeper and provide the most effective and equitable care. That’s why Vori Health believes in a different approach to care for individuals with chronic MSK pain.

We know that pain is a different experience for everyone, and our goal is to help each individual reach their goals and improve their physical and mental health by providing the right kind of care. Our holistic care model meets patients exactly where they are with the care they need—no biases, no judgment, and zero opioids. Vori’s physician-led multidisciplinary care teams strictly practice evidence-based medicine, recognizing that females often have more intense pain experiences and should receive the level of care that matches their pain.

When patients connect with their Vori Health care team, they have total peace of mind that their clinicians will listen to every concern and prescribe care that specifically addresses those needs. We don’t just strive to reduce pain—our goal is to help each patient feel heard, supported, and ultimately, achieve a higher quality of life through this comprehensive, patient-centered approach, our care teams are paving the way for more equitable, effective, and high-value MSK care for all sexes and genders.

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Discover more about how Vori Health’s evidence-based care teams are closing the sex and gender gap in MSK care.

REFERENCES

• USBJI, 2024: Musculoskeletal Diseases and the Burden They Cause in the United States. United States Bone & Joint Initiative. https://www.boneandjointburden.org/  
• Dawes, 2021: Dawes JM, Bennett DL. Addressing the gender pain gap. Neuron. 2021;109(17):2641-2642.
• Bartley, 2013: Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52-58.
• Overstreet, 2023: Overstreet DS, Strath LJ, Jordan M, et al. A Brief Overview: Sex Differences in Prevalent Chronic Musculoskeletal Conditions. Int J Environ Res Public Health. 2023;20(5):4521.
• Xiang, 2016: Wáng YX, Wáng JQ, Káplár Z. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quant Imaging Med Surg. 2016;6(2):199-206.
• Samulowitz, 2018: Samulowitz A, Gremyr I, Eriksson E, Hensing G. "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018;2018:6358624.  
• Majedi, 2019: Majedi H, Dehghani SS, Soleyman-Jahi S, et al. Assessment of Factors Predicting Inadequate Pain Management in Chronic Pain Patients. Anesth Pain Med. 2019;9(6):e97229.  
• Moretti, 2023: Moretti C, De Luca E, D'Apice C, Artioli G, Sarli L, Bonacaro A. Gender and sex bias in prevention and clinical treatment of women's chronic pain: hypotheses of a curriculum development. Front Med (Lausanne). 2023;10:1189126.

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