Apr 22, 2024 - Health

"Not acceptable": Doctors start to take women's pain more seriously

Illustration of a woman sitting on an exam table with a robe with neuron imagery on it

Illustration: Natalie Peeples/Axios

There are growing efforts in medicine to correct a major blind spot: women's pain.

Why it matters: The impact of social media testimonies and a greater systemic focus on women's health are helping drive a shift in how providers treat women's pain, especially for reproductive care.

  • "There's a lot of unfortunate history of women's pain being dismissed, particularly for women of color, but it does seem like there's more conversation about it," said Neel Shah, chief medical officer of Maven, a virtual women's care company.

Driving the news: Earlier this month, the American Society of Anesthesiologists offered new guidance on pain management for women undergoing C-sections shortly after a study found 15% experience pain during the procedure.

  • "That's just not acceptable. We want to drive it down to zero," said Mark Zakowski, chairman of the ASA committee that wrote the new guidelines.
  • He said it's part of the field's changing approach to pain, which includes moving away from measuring pain on a 10-point scale — which doesn't capture the complexity of pain — to instead making patients more involved in decision-making.
  • For instance, some pain-relieving drugs may make it harder for pregnant patients to remember delivery, which may be an unacceptable tradeoff for someone who wants the memory of their child's first cry, said Robert White, an obstetrical anesthesiologist at Weill Cornell Medicine.

The big picture: Other recent stories about the regularity with which women experience pain during routine care have brought attention to the issue with sometimes shocking details.

  • "Women are advocating right now online for pain management and pain options," said Jenny Wu, a third-year OB-GYN resident at Duke University.
  • Wu is co-author of a study, recently featured in the Washington Post, that found women who shared videos of IUD insertions on TikTok often focused on excruciating pain and side effects.
  • "Patients are talking about feeling like their pain wasn't addressed, their pain was dismissed by an OB-GYN during a procedure," Wu said, adding that she's seen a shift in discussions about pain even during her training.
  • "I feel like it's very much changed how I practice my care."
  • Wu said she's changed her pain vocabulary to be more specific. For instance, she tells patients that they may feel a "strong cramp" instead of using common but vague terms like "pressure."

In one particularly disturbing example, a podcast called "The Retrievals," from Serial Productions and the New York Times, last year spotlighted stories of women undergoing egg retrievals for in vitro fertilization without medication because their nurse had stolen it.

  • It highlighted an extreme case, but it took place at an academic medical center with a great reputation and great outcomes data, raising concern about how commonly poor pain management could slip through the cracks, Shah said.
  • "As soon as I heard that podcast, I made sure that we would know if our members are ever suffering like that," Shah said.

The bottom line: Shah said he sees it as part of a bigger shift, pointing to President Biden's call to invest $12 billion in women's health research during the State of the Union.

  • "I think we're really living at a moment that's an inflection point where there's broad recognition and momentum to create gender equity in the health care system," Shah said.
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