Awareness Days, Chronic Pain, International Women's Day, Women's Health

International Women’s Day – Chronic Pain & Self-Advocacy

Our penultimate International Women’s Day post is about the differences between men’s and women’s experiences of care in regard to their chronic pain, where you can find help and how to advocate for yourself.

Before we delve into this topic we would like to highlight that the aim to raise awareness for women’s experiences does not diminish the struggles men face with chronic pain, there is a need for reform for all chronic pain suffered. This piece serves to highlight the way others sometimes approach women and men differently. The advice provided on where to seek help and how to self-advocate is for everyone.

Let’s start with some facts and statistics…

Chronic pain is characterised as daily pain for 3 months or longer. A systematic review by Anke Samulowitz in 2018 was titled “Brave men” and “Emotional women”, confirming that doctors’ perceptions of and interactions with patients were different dependent on their gender. Research shows that men, viewed as heroic for carrying on in the face of pain, are more likely to be listened to, physically investigated, treated effectively and receive pain relief. Women and gender-diverse people were more likely to be prescribed antidepressants or referred to a mental health service without the physical investigations.

According to a study by Fayaz, et al. (2015) the estimated prevalence of chronic pain in the UK is 43%. In a survey by Public Health England in 2017, 38% of female respondents reported chronic pain compared to 34% of male respondents.

Furthermore, there are 10 chronic pain conditions that have similar symptoms and predominantly affect women, these are:

  • Endometriosis
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Irritable bowel syndrome
  • Painful bladder syndrome
  • Migraine headache
  • Chronic tension-type headache
  • Temporomandibular joint disorders
  • Chronic lower back pain
  • Vulvodynia

Research has found that once a person has one of these conditions they are more likely to accumulate more of them. Some of these pain conditions have a high rate of co-occurrence with autoimmune conditions including rheumatoid arthritis, lupus, Sjogren’s syndrome and thyroid diseases. Many of these conditions can be well managed early but due to delays in diagnosis it can often take years before a person can access the correct treatment.

Anecdotally, many women report that they don’t feel their doctor has taken them seriously, or they have been told their pain is psychological and that they feel like they are going round in circles. This scenario is a self-fulfilling prophecy because the distress caused by lack of diagnosis can exacerbate the symptoms significantly, leading to highly emotional responses which leads us full circle to the idea that women are hysterical and their pain is caused by depression. This is the circle we are trying to break.

Where To Seek Help

Osteopaths

Of course, an osteopath saying you should visit an osteopath… sounds incredibly biased but hear us out.

Osteopaths spend between 4-5 years learning about anatomy and physiology, developing their skills in case history taking, investigation, physical examination and diagnosis in a classroom and clinical setting. They spend a minimum of 2 years working as a lead practitioner with real patients before they graduate university as part of their 1200 required clinical hours. They are trained to perform neurological, respiratory, gastrointestinal and cardiac examinations, combined with physical exams; this allows us to screen for underlying conditions that may not have been detected yet.

Osteopathic appointments are also much longer in comparison to a GP appointment due to being mostly private practitioners. They are interested in examining you as an entire person, taking into account your lifestyle and general overall health, not just focusing on the painful area. We do ask about your mental well-being, not because we’re going to blame your pain on psychological factors, but because we want to understand how much of an impact this is having on your life and set goals for treatment.

Sam at Wisbey Osteopathy has a special interest in chronic pain patients because she is a chronic pain patient herself. Sam has experienced what it can be like for patients who are lacking a diagnosis, the frustration of being told your tests have come back clear and yet still being in pain, the long wait times and what feels like repeated dismissal of symptoms having a severe, debilitating impact on your life. She understands the importance of being listened too, referred to the appropriate medical department and gaining a correct diagnosis. Sam is highly trained in the treatment and management of chronic pain both academically and personally. She strives to streamline the diagnostic pathway as much as possible so she can prevent others from experiencing the same struggles she went through.

GPs

Until this point in the post the GPs have been painted in a bad light, but let us remind you that there are many fantastic doctors who will take you seriously and will refer to to the right department for further tests. Their medical decision making is largely restricted due to NHS protocol and short consultation times.

The job of your GP is to screen for major red flags that could indicate a life-threatening condition and make a decision based on their initial questions. They will often go with treatment which fits the most likely cause, if that doesn’t work they expect you to come back and they try the next most-likely treatment option. It can sometimes take 3+ visits before a referral for further tests is made because they are required to have tried other options before making a referral. The NHS is already oversubscribed and underfunded which means referrals are made after exhausting other options first to limit the number of unnecessary investigations which contribute to longer waiting times.

Other Healthcare Professionals

Examples of other medical professionals that may be able to help with pain management and diagnosis, depending on the pain being experienced include podiatrists/chiropodists, dietitians, dentists and talking therapists. Some people find symptom management is achieved with alternative therapies such as massage, reflexology or acupuncture.

Online Resources

How Can I Advocate For Myself During Medical Appointments?

  • Be persistent – I know that it can be frustrating and time consuming to keep make doctors appointments but repeatedly telling them the latest treatment is not working will exhaust there initial options quickly and escalate to further testing.
  • Be firm – don’t allow anyone to dismiss you, your pain or your concerns. If you feel they haven’t explained their thinking then ask questions until you understand.
  • Ask for a second opinion – you are well within your right to ask to be referred for a second opinion on your presenting symptoms if you are dissatisfied with the care you have received.
  • See an osteopath – we know, this is the second time we’ve suggested seeing an osteopath (shock!) but osteopaths are incredibly skilled. They will do a full physical examination along with any special testing you may need. We cannot refer directly to an NHS department so unless you would like to go private we can refer you to your GP. We will send a letter detailing all of the examination results with a recommendation on who you need to see next. If this letter is ignored we can request a second opinion and advocate on your behalf.
  • Arm yourself with knowledge – I will very rarely advise patients to do this, but when you have been in chronic pain the chances are you already have an idea about what could be wrong. Read up on those conditions so you have a better understanding of how to be investigated effectively.
  • Ask for a referral – it’s a more direct route to take and may be met with resistance from some doctors but asking and clearly stating your reasons can can be the push your doctor needs to write the referral.
  • Keep your own records – keep a pain dairy, with notes of what time, day, activity and pain type you have experienced. It can even be helpful to record dates of each medical visit so you have a clear record of everything and won’t miss and pertinent details when answering questions during short GP appointments.
  • Take back up – you are legally allowed to take a chaperone with you to your medical appointments, they can sit there quietly for moral support or be there to firmly advocate for you if you lose courage or forget one of the questions you wanted to ask. It’s nice to know someone has your back.

We will be writing a few more posts for chronic pain so watch this space!

Fayaz A, Croft P, Langford RM, et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies.BMJ Open 2016;6:e010364. doi: 10.1136/bmjopen-2015-010364

Samulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018 Feb 25;2018:6358624. doi: 10.1155/2018/6358624. PMID: 29682130; PMCID: PMC5845507.

Photo by Sydney Sims on Unsplash