Research Paper: A Bias Against Women in the Treatment of Pain

Sex-based treatment in medicine is a relatively new concept, as a result, little has been adequatly researched and descried in this field. Until recently (1993), women have been left out of research trials for drugs, experiments and various treatments due to the possibility that the independent variable may affect women's future offspring (Hoffmann et al,13). In addition, a woman's menstrual cycle causes fluctuation in vitals and hormones making conclusions difficult to draw. The purpose of this field is to acknowledge that there are vast differences between males and females, not just anatomically speaking, but also psychologically speaking. In order to provide the best care possible, these differences need to be taken into consideration. I would like to acknowledge that when reffering to sex, I am speaking of the biological concept on XY and XX chromosomes. When referring to gender, I am speaking about the social concept of what one identifies as.

The article “The Girl who cried pain: A bias Against Women in the Treatment of Pain” by Dianne E. Hoffmann and Anita J. Tarzian produces an effective argument in acknowledging the differences in pain amongst men and women and analyzing how the healthcare system responds to these differences considering the rhetorical context of the article. This article is a scholarly peer-reviewed article published in the Journal of Law, Medicine and Ethics. In other words this article’s audience is for educated readers or readers who are interested in learning about the topic. The vocabulary used in this article is a good indicator of the audience, because, although there is definitely advanced vocabulary, the authors explain through context what the medical terminology means. The article was published in 2001, whilst outdated, this topic is still very relevant. As a result of it’s publication date, I can tell that this article is very at the beginning of its time in regards to the conversation surrounding sex-based healthcare. I feel as though this topic is still not as frequently discussed as it should be, considering its benefits.

In summary, the main points of this article exhibit that women and men experience pain differently, however these differences are not proportionally accounted for in treatment. There are differences in female and male biology that may account for women to feel more pain such as pelvic reproductive organs and cyclical changes in hormones and/ or types of hormones. For example, females report higher levels of joint pain when they have lower estrogen levels (Hoffmann et al, 14). In addition to biological factors, cognition, emotion and cultural differences all play a part in the experience of pain. There are psychological and behavioral differences among men and women which reflect the way the sexes report pain. For instance, women go through a sorting process when addressing if pain is due to normal biological processes, such as menstruation or childbirth or due to an alternative source, men do not go through this process (Hoffmann et al., 16) . Furthermore, women report pain using context, where men report objective physical symptoms or limitations (Hoffmann et al., 16). In the United States, men are programmed by society to feel ashamed of vulnerability as a result, they don't report pain until it affects their ability to work or limits them.

From the beginning, the authors skillfully gain the reader's attention. Hoffmann and Tarzian grab the attention of the audience by starting the article with a biblical quote, “To the woman God said, 'I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband and he shall rule over you.'" (Genesis 3:16). However effective, this hook doesn't bring in the audience that would agree with Hoffmann and Tarzian’s perspective of pain amongst the sexes. Which brings me to the conclusion that, another purpose of her article is to teach the public about sex-based healthcare and dismiss some percieved notions and bias about pain amongst woman. The author's opening line is effective in intriguing readers and provoking emotion, however, I do think it is unprofessional to bring religion into the argument, due to the fact it may disrespect some reader’s religions. Consequently, the opening statement also might cause a reader to continue reading with bias and dismiss any assumption that does not align with their religion. Contradictorily, by including a biblical quote the authors might be trying to reach a consensus with religion in hopes of eliminating stereotypes.

The authors then go into a brief outline of what the article will contain. The organization of this article is very fitting for the audience, it is not necessarily a scientific article consisting of the abstract, introduction, methods etc. rather, it categorizes the differences in pain that exist amongst females and males, then states the scientific reasoning as to why these differences prevail. An example of a title is “Behavioral coping” and “Psychological and cultural gender differences." The style of writing is very straight to the point and is a good mix between qualitative and quantitative data. In the scientific world, this article may not be considered effective because it validates one's own position using others' research, instead of research conducted by the authors. However, Tarzian and Hoffmann fairly present each scientist's research and give credit accordingly.

The authors examine three separate articles about the differences in pain in an experimental setting. By examining three different articles, Hoffmann and Tarzian draw a very well-rounded conclusion that in laboratory settings women experience lower pain thresholds. In addition, Tarzian and Hoffmann cite literature that uses mice and rats as the experimental subjects in regards to immune chemicals in the hippocampus and septum and stress induced analgesia response. Human brains and brains of mice and rats differ therefore, this research could be claimed as inapplicable. The authors acknowledge the limitations of citing research in animals other than humans, adding to their credibility, “Animal studies provide compelling evidence that basic biological differences do exist; however, pain in these studies is measured differently from how it is measured in humans” (Hoffmann et al., 18). 

Hoffmann and Tarizan not only address biological differences that may account for differences in pain amongst sexes, they also address physiological ones and a combination of both: mind-body connections. The authors add to their credibility by addressing one of the limitations of their article. In order to accurately study the mind-body connection that attributes for pain tolerance, sensitivity, etc., they would need to study participants in a natural, nonexperimental setting, which in most cases would be unethical. Participants can recall past moments of pain, however information may be lost or distorted, due to the fact that recall comes from memory. There is not enough known about memory to draw conclusive results.

When discussing the differences in treatment for pain among male and females, the authors use an example that elicits an emotional response in the readers. A study about post-operative pain in children was cited in which “more codeine was given to boys than girls and that girls were more likely to be given acetaminophen”(Hoffmann et al.,17). Girls who had just undergone surgery were given tylenol, a drug most people take for headaches. The biological differences between women and men that pertain to hormones, are most often not seen in children due to the absence of puberty.

When addressing what the authors propose to do to better treat the differences in pain amongst the sexes, the authors state the current problems, then give their line of reasoning for making certain changes, allowing the readers to fully comprehend how they came to the conclusion of how to better suit the healthcare system. For example, first the authors state the problem, “women are more likely to be given sedatives for their pain and men to be given pain medication,” (Hoffmann et al, 13). Then, they give their line of reasoning for the solution, “previous research has shown that men and women metabolize medication differently,” (Hoffmann et al, 18). Finally, they give their solution, “genetic research will lead to identifying drugs for pain that are specific to men’s and women’s biological needs,” (Hoffmann et al, 18).

In conclusion, the article “The Girl who cried pain: A bias Against Women in the Treatment of Pain” by Dianne E. Hoffmann and Anita J. Tarzian, successfully presents the argument for their intended audience through their organization, acknowledging their limitations and addressing the differences in pain between male and females in all perspectives: biological, psychological, cultural and mind-body connection. It is accepted that females experience more frequent and greater pain, but do not receive equally proportional treatment.