• Robb G. Best

The Mistake We Make When We Estimate Others' Pain

At some point in your life, you have likely been asked to estimate your current pain level on a scale of one to ten. Sounds relatively simple, right? Unfortunately, it appears there are a few hiccups in this process.

A new study co-authored by Elizabeth Losin, assistant professor of psychology and director of the Social and Cultural Neuroscience lab at the University of Miami, found that observers tended to view women's pain levels as lower even when the women reported the exact same degree of pain as men. (Other co-authors include the study’s lead author, Lanlan Zhang of Guangzhou Sport University, Yoni K. Ashar of Weill Cornell Medical College, Leonie Koban of Paris Brain Institute, and senior author Tor D. Wager, Dartmouth College.)

According to the study, researchers found that when male and female patients reported identical levels of pain, observers--regardless of their own gender--were more likely to view the female pain as less, and more likely to recommend psychotherapy as treatment instead of medication.

The first of two experiments had 50 volunteers watch clips of men and women afflicted with shoulder pain performing motion exercises using their injured and uninjured shoulders. These clips were each drawn from a database, which also included the patients' self-reported pain level when moving the injured shoulder.

Losin believes that playing actual videos of people in real pain will yield more useful results than in previous studies, which used actors pretending to be in pain. “One of the advantages of using these videos of patients who are actually experiencing pain from an injury is that we have the patients’ ratings of their own pain,” she said. “We had a ground truth to work with, which we can’t have if it’s a stimulus with an actor pretending to be in pain.”

An additional grounding truth: researchers analyzed the injured people's facial expressions through the Facial Action Coding System (FACS), an extremely detailed system designed to describe basically every facial movement a person can make. This was used to create an objective way to measure the intensity of pain in each person's face.

The participants in the study were then asked to estimate the pain level of each person in the video, from one (no discomfort) to 100 ("worst pain possible").

The second experiment recruited 200 people. After enacting the first experiment again, these 200 study participants were asked to complete the Gender Role Expectation of Pain questionnaire, which is designed to gauge the individual's gender-related stereotypes with regards to pain sensitivity, how people endure pain, and people's willingness to report pain. The 200 respondents were also asked how much medication and psychotherapy they would prescribe for each patient, and which of the two they believed would be more effective in treating the patient.

The results held that women who reported the same level of pain--and exhibited the same level of pain in their faces--were considered to be in less pain than men. Examining the answers to the questionnaire, the researchers were able to conclude that the gap was a result of gender stereotypes as they relate to an individual's stoicism, or lack thereof.

“If the stereotype is to think women are more expressive than men, perhaps ‘overly’ expressive, then the tendency will be to discount women’s pain behaviors,” said Losin.

“The flip side of this stereotype is that men are perceived to be stoic, so when a man makes an intense pain facial expression, you think, ‘Oh my, he must be dying!’ The result of this gender stereotype about pain expression is that each unit of increased pain expression from a man is thought to represent a higher increase in his pain experience than that same increase in pain expression by a woman.”

Losin explained that she got the idea for the study from previous research which had found that women are often prescribed less treatment than men and tend to wait longer for that treatment also.

“There’s a pretty wide literature showing demographic differences in pain report, the prevalence of clinical pain conditions, and then also a demographic difference in pain treatments,” said Losin. “These differences manifest as disparities because it seems that some people are getting undertreated for their pain based on their demographics.”

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