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Gender biases in estimation of others’ pain, 2021, Zhang L et al

Discussion in 'Other Health News and Research' started by Sean, Mar 23, 2021.

  1. Sean

    Sean Senior Member (Voting Rights)

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    Highlights
    • In two studies, perceivers under-estimated female patients’ pain compared with males’ pain.

    • Perceivers’ pain-related gender stereotypes predicted pain estimation biases.

    • Perceivers prescribed more psychotherapy for female and more pain medicine for male patients.

    Abstract

    Caregiving and other interpersonal interactions often require accurate perception of others’ pain from nonverbal cues, but perceivers may be subject to systematic biases based on gender, race, and other contextual factors. Such biases could contribute to systematic under-recognition and under-treatment of pain.

    In two experiments, we studied the impact of perceived patient sex on lay perceivers’ pain estimates and treatment recommendations.

    In Experiment 1 (N = 50), perceivers viewed facial video clips of female and male patients in chronic shoulder pain and estimated patients’ pain intensity. Multi-level linear modeling revealed that perceivers under-estimated female patients’ pain compared with male patients, after controlling for patients’ self-reported pain and pain facial expressiveness.

    Experiment 2 (N = 200) replicated these findings, and additionally found that 1) perceivers’ pain-related gender stereotypes, specifically beliefs about typical women's vs. men's willingness to express pain, predicted pain estimation biases; and 2) perceivers judged female patients as relatively more likely to benefit from psychotherapy, whereas male patients were judged to benefit more from pain medicine.

    In both experiments, the gender bias effect size was on average 2.45 points on a 0-100 pain scale. Gender biases in pain estimation may be an obstacle to effective pain care, and experimental approaches to characterizing biases, such as the one we tested here, could inform the development of interventions to reduce such biases.

    https://www.sciencedirect.com/science/article/pii/S1526590021000353

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  2. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    This paper appears to me to be largely re-inventing the wheel. This effect of estimating pain to be less in women than in men has been demonstrated before. There is also an assumption that women believe themselves to be in great pain more readily than men because they are more likely to be attention-seeking and mentally ill.

    How this affects a woman in severe pain because of a dangerous physical problem is described very well in this article written by the woman's husband :

    https://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/
     
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  3. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    To perhaps be guilty of mansplaining, I think it is important we demonstrate as much as possible the gender biases of the medical profession to ensure better management of conditions that impact on woman more than men and also to avoid the harms caused by MUS misdiagnoses.

    As a man I believe I have been better treated by the doctors I have come into contact with than most/many? women with ME are treated, but in contrast I have suffered equally in the lack of research and the mischaracterisation of our condition as a psychiatric condition that has resulted from it impacting on more women than men.

    So though not Earth shattering these studies are still important.

    [corrected typos]
     
    Last edited: Mar 23, 2021
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  4. Hutan

    Hutan Moderator Staff Member

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    To play devil's advocate:

    What if a culture did result in men on average down-playing how much pain they have when they talk about it - or in women being more likely to show that they had pain in their facial expressions? It seems conceivable to me that this could be possible in some societies. Sayings like 'boys don't cry' don't come from nowhere. In that case, perhaps perceivers could be more accurate on average when perceiving people's pain if they take gender into account.

    Of course, even if stereotypes have a little bit of truth in one culture, applying them could produce very bad outcomes at the individual level, or in a different culture.

    It's not that big of a difference. I actually would have expected it to be much bigger - I think it probably depends on the society that the perceivers come from.

    This was interesting
    (sorry, have edited)
     
    Last edited: Mar 23, 2021
  5. Sean

    Sean Senior Member (Voting Rights)

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    It isn't much, is it. Especially for something so difficult to pin down (i.e. heavily subjective at every level).
     
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  6. Milo

    Milo Senior Member (Voting Rights)

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    @Peter Trewhitt i will take your mansplaining any time, thank you for your words. I suspect that men have access to more medicine and more tests, and in fact it would make for a good retrospective, chart review study, if we only had that to worry about.

    What is fascinating is that increasingly we read research about sex differences in the biology of ME, as highlighted by the work on this post this week end (of course, larger study and replication is needed).

    What is devastating is that this is still going on in 2021 and entire diseases are involved.
     
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  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I don't understand how anyone knew how much pain there really was.
    I am not aware of any valid way to compare one person's pain with another - the scales we use are designed to compare one person's pain with that person's pain at another time.
    This looks a bit like PACE - finding what you set out to find - but actually much less effect than everyone might have expected simply from the sort of bias likely to have crept in.
     
  8. Trish

    Trish Moderator Staff Member

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    That struck me too. I have no idea how pain can be gauged objectively. Even with the same type of injury or painful event, it's hard to know whether two people, regardless of gender, will experience the pain the same.

    One thing that has struck me over the years is that it is sometimes other women who are least sympathetic about women's pain.

    For example, mothers telling their daughters that period pains are just something you have to live with and should never mention or stop working because of crippling pain (as my mother did to me).

    And when I was having children, there was a woman who wrote books about 'natural childbirth' and telling women to see the pains of childbirth as postive and lovely things, and then we wouldn't need pain relief, we could just breathe through the pain and think beautiful thoughts. She clearly based her ideas on her own good fortune of having minimal pain herself in childbirth, and assuming other women just needed to be taught to think like she did.
     
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  9. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    Exactly.

    When it comes to BPS codswallop then someone showing no objective signs of improved function are believed when they say they are recovered but not when they they say they feel worse.

    Similarly, if someone says their pain levels improved that's great but we tend to be less supportive & believing when the pain goes above & lasts longer than some arbitrary point. An arbitrary measurement of a subjective experience at that.

    Surely, what matters here is that the pain is preventing the person from functioning and is interfering with their life?
     
    Last edited: Mar 23, 2021
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  10. Hutan

    Hutan Moderator Staff Member

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    This was my reaction to the abstract too. I did start reading the paper, and that wasn't quite the question they answered though, at least for part of the study.

    It seems that they found that women's pain was perceived to be (slightly) lower than mens in video clips with the same amount of facial expressiveness. (And self-report pain levels were correlated with facial expressiveness.)

    So, they sort of did not need to know how much pain there really was. They found that if men and women in video clips are equally expressive of pain, the rating of pain by an observer is (slightly) lower for the video clips of women.

    (but yes, it is all a bit circular, subjective and vague)
     
  11. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    For anyone who stops and thinks for a moment that is completely the wrong way around. Sure men typically played sports that were more violent & where injury was more likely.

    On the other hand women generally weren't supposed to go around discussing or whinging about *ahem "women's trouble" *.

    So women, even those with bad period pain, were supposed to.just get one with it despite being in pain for several days or even one week out of four.

    Of course for those susceptible to the hormone headache which can occur just before, during or after a period that can be an extra day or two of pain too.

    Unless you were incapacitated by it, you were supposed to just carry on.

    Women have been conditioned for generations not to make a fuss about pain & to carry on without showing it.

    As for women being quicker to seek help - until very recently a woman who worked was also still largely responsible for the bulk of the household chores & making sure the children were fed, watered and in school on time. They couldn't afford to be sick because, as often as not, there was no one else to do it all for them. Seeking help earlier than men could just as easily be through a sense of duty to their family as anything else.
     
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  12. Ravn

    Ravn Senior Member (Voting Rights)

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    The main thrust of the paper (have only read the abstract) seems to be about the perceivers' judgements. I wonder why they didn't go digital instead of using actual patients and trying to do the impossible, i.e. somehow measure and match "true" levels of pain and facial expressiveness?

    Start with a computer-generated androgynous face and overlay it with various levels and types of pain expression. Give half of the pictures stereotypical male features like a mustache and the other half stereotypical female features like a feminine hairdo. Then ask perceivers to rate how much pain they think the digital person is in. This should give a somewhat clearer picture of any specific gender effect (at least until such time as gender diversity has made visual male-female distinction too hit & miss, by which time we may no longer need studies such as this).

    Similar studies have also been done on perceivers' judgement of pain in people of different colour, with predictable results.

    Point 2) appears to me the more significant finding though it only restates what others have already found. But until the situation has changed I guess it has to be restated over and over again, basically saying each time that "see, it's still a problem".
     
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  13. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    Staying straight-faced and still when in pain can be taught, up to a point, if you start early enough.
     
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  14. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    Yep. I stood on a fire ants nest, wearing a pair of flip flops one day. I was stood there for a good 5 minutes as a neighbour wanted to talk to me about something really important.

    I was in pain anyway and feeling lots of stinging on my feet & lower legs. My neighbour didn't notice a thing, my husband didn't notice a thing.

    I only stayed there because I am so used to getting random stinging and burning sensations that it didn't occur to me I was being stung or bitten.

    It hurt but obviously I masked the pain from expression well. When you are used to pain you get quite good at hiding it.
     
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  15. alktipping

    alktipping Senior Member (Voting Rights)

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    " I masked the pain from expression well. When you are used to pain you get quite good at hiding it. " so clearly stated by invisible woman . this i think is a major problem with chronic pain i hate being asked every five minutes if i am okay and would of course do my best to hide any outward signs of discomfort . then their is the predator and prey response we know full well that some people will and do take advantage of others who show any sign of perceived weakness .
     

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