It was the second time she had been to the emergency department with pain. It was also the second time she was sent home without answers. With each visit, I felt increasingly helpless as a nurse and a daughter, as my mom called me in excruciating pain on her way to the hospital.
After the first visit, I had helped her navigate the healthcare system and get appointments with various specialists and her primary care provider. Yet, here she was, in the emergency department a second time with unresolved, under-managed, and unbearable pain.
Many factors within the healthcare system contribute to under-managed pain in women — which is especially prevalent in older and middle-age women. I am all too familiar with the fact that we have a taxed healthcare system, but there is also an unfortunate history of dismissal of women’s pain. Pain in middle-age and older women is frequently dismissed as a “normal part of aging,” both within society and within healthcare. My mother, my patients, and my research participants have expressed far too many times that they left a visit with no plan for their pain, and were told it was just arthritis and to work on losing weight.
Under-managed pain in middle-age and older women is a deeply concerning issue. Yet, many fail to recognize the dire consequences. We need this to change.
The Consequences of Unmanaged Pain
Among those experiencing chronic pain, 70% are women. Under-managed pain in older women can lead to reduced quality of life, frailty, difficulty with physical activity, and poor mental health outcomes. Among middle-age and older women from underserved and underrepresented groups, under-managed pain only further expands the gap in access to necessary healthcare and contributes to health disparities. All this and I haven’t even gotten to the cost: chronic pain costs the nation an estimated $560-635 billion each year (in 2010 dollars) in pain management care, disability payments, and lost work productivity.
This is clearly an issue affecting not only those patients living in pain and their families, but society at large.
Acknowledging Their Voices and Responding to Their Pain
It’s high time to take action beyond just being aware of this burden of pain.
Chronic pain in women should be at the forefront of research agendas. We must find innovative ways to build on our previous work to better assess, treat, and understand chronic pain mechanisms and experiences among women. With the new White House Initiative on Women’s Health Research, it is imperative that researchers recognize chronic pain as a condition that disproportionately affects women and has severe consequences. As First Lady Jill Biden stated, no woman should have to hear “it’s all in your head.“
We, as clinicians, must move forward from simply acknowledging that pain exists for middle-age and older women and make it a priority for their voices to be heard. It is imperative that we provide space and opportunities for women to go beyond the limited 0-10 pain scale and express their unique pain experiences. Using culturally aware assessment methods is also an important aspect of providing space for women to voice their pain and ask questions about it.
Through my research, I’ve learned that putting women at the center of their pain management is a crucial component in improving their pain and quality of life. For example, women in my study identified their goals in pain management, such as being able to sit or stand for longer periods at work, or to better manage their pain while at home. Building on their experiences, it is important that women can identify the goals they would like to achieve in their pain management rather than clinicians setting the goals and pain management regimens for them. We have found that when women express what is meaningful to them, their pain management plans are more sustainable and realistic, and their pain and mood also start to improve.
For clinicians specifically, pain management should be founded in shared decision making with middle-age and older women. In addition, developing pain management plans that are tailored to women’s needs is imperative in managing their pain and improving long term outcomes.
A Worthy Investment
We have the potential to change healthcare as we know it for women experiencing chronic pain. At first, it may cost more to go this extra mile, but in the end the costs of pain management and lost productivity would likely decrease. Most importantly, we owe it to women like my mom and the women in my research studies to hear and believe them.
It is the heartbeat of healthcare to believe our patients, and our duty to hear their stories and work with them to manage their pain. It is the duty of researchers and clinicians to respond to their stories to help improve outcomes.
Janiece Taylor, PhD, MSN, RN, is an assistant professor on the research/education tract at the Johns Hopkins School of Nursing in Baltimore.
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