Men, Women, and Pain
If you’ve been to the doctor’s office recently with any kind of complaint, it’s likely you were asked to rate the pain you were experiencing on a scale from 0 to 10 (being the worst pain possible). Well, a group of researchers from the Stanford University School of Medicine recently analyzed the self-reported pain measurements from 11,000 medical records from 2007-2010 and discovered something surprising: women report greater levels of pain than men for the same injuries and ailments.
In The Upside of Irrationality, I briefly discussed a disagreement I had with a professor about the difference in pain tolerance between men and women. My professor, Ina Weiner, maintained the view that women have a higher tolerance in order to cope with childbirth, and she was unimpressed by the story I told about a woman I’d met in the burn unit who confided in me that the pain of her burns was far worse than what she experienced in childbirth. As you might expect, I decided to run a small experiment, and asked the men and women who passed by my cubicle (where I worked as a research assistant) to submerge a hand in hot water and keep it there until the pain became unbearable. Meanwhile, I timed them and recorded their gender.
The next day in class I was excited to describe my experiment and to report that the men who participated kept their hand in the hot water for much longer than the women. Professor Weiner replied that all I’d proven was that men were stupider—after all, who would subject themselves to such pain just for my silly study? Naturally this took the wind out of my sails, and I left the subject alone after that.
But as it turns out, the women analyzed in this study reported more intense pain—an average of about 20% more—for equal-opportunity afflictions ranging from neck and back pain to viral Hepatitis. While the experience of pain and the way people report it is inevitably subjective (for instance, the presence of a concerned family member might lead someone to downplay their pain), it’s likely that the large number of people included in the analysis counterbalances social and individual differences.
And while I would never say “I told you so” to a former teacher, I do hope that this research might make its way somehow to Professor Weiner.
For the original paper, click here.
The Honest Truth About Dishonesty: How We Lie to Everyone - Especially Ourselves
Now I can scientifically prove my wife that she is just whining a lot today!!!!! It’s a small step in research but a big step for men!!!
I like what Professor Weiner said. Let’s just leave it at that. If anyone has been through absolute agony. It’s me. Regardless of 70 operations, 23 broken bones, 1000+ days in the hospital, 2 catastrophic accidents at 13 and 15. 3 months in traction with a complete degloving from upper thigh to toes. Complete heel loss. I have the graphic pics. No settlement. Long story, Then comes above knee amputation 15 years later. Now for 15 years I’ve been living a much worse nightmare then the above. Phantom Pain. My foot feels like its in a crushed down position, with a vice filled with razors is closing tighter and tighter. Foot has fire ants all over. Feels like its stuck in a garbage disposal. Has about destroyed my life from the domino effect of everything. Now take a woman who had a congenital deformity and who’s leg was amputated at a young age. Totally different. She has a much better outcome with prosthetics and rarely if ever has phantom pain. There are so many variables. I think the study was another waste. I’m totally burned out.
stacilyn68
Have you seen the TED lecture by VS Ramachandran on treating phantom limb pain:
http://www.ted.com/talks/vilayanur_ramachandran_on_your_mind.html
It seems to me that willingness to report pain is not necessarily the same thing as pain tolerance. Men may be less likely to report feeling pain, but that doesn’t mean that they actually feel less pain or are more able to function while experiencing pain. Men are under greater social pressure to “act tough”, but that isn’t the same thing as actually being tougher. (I’m male, if anyone is curious about my biases…
)
I thought that too, but then that social pressure seems to actually make you tougher (remember that men lasted longer in the experiment with hot water).
So, men are actually tougher, what is unknown is wether this is because of biological gender or social role.
I agree with you Morgan, I think it is a lot easier to admit pain if you are from the “soft” gender. I can easily cry in public if I fall down the stairs, if a man did so I would probably find him a bit of a whiner…
But not just that — women also expect to be underserved in a medical setting. If I had a nickle for every time I was told it was in my head. . .I had to go through all kinds of insanity just to get a morphine shot when I’d shattered my elbow. “We just can’t take a chance on addicts faking it for a fix,” the doctor said. RIGHT. How do you fake shattered joint? If a man walks into a hospital and reports a 6 in pain, he gets treated. A woman has to walk in and report a 9 just to get the same level of concern out of the personnel.
I assume it depends not only on gender but also differ from country to country where affected by national and geographic traditions. For example, in Russia I contemplate lots of examples where women much more bearable to pain compare with man.
Men like to look tougher, than they really are… So, in many cases they causing much more pain for themselfes, just beacause it makes them more masculine. When you make an experiment like this, isnt that possible, that the women was just more honest of their pain tolerance level than men?
You know: “no pain, no gain”
What about the cultural pressure men have (and women don’t) to look tough and stoic?
I wonder though, if this might not be just a result of the scale. Since perception of pain, I assume, is like any other sense – relative, maybe women just find it harder to imagine comparable pains. What if instead of a meaningless scale of 1-10, a scale of examples were used (i.e. 1=papercut, 5=hitting your pinky on the corner of a table, 10=something really horrible).
What if women just have more limited imagination when it comes to pain? Or they’re just more optimistic than men (thinking along the line of “It can’t get much worse than this”) Or maybe they perceive the scale in a non-linear way (i.e. the difference between 10 and 9 is greater than the difference between 9 and 8)?
Morgan, check this out
Phantom Limb Pain – A nightmare most patients won’t admit!
behavioralmedicinedigest.wordpress.com/tag/phantom-pain/
Copy and paste link and then click on HOME PAGE right above the caption. It talks about phantom pain and about how often our veterans admitted to it. Now this is different because so many uninformed or those who just think phantom pain is all in your head. Like you have a psychological issue. I realize that’s not the real subject but its a informative
Women cause themselves alot of mental and emotional and even physical pain to look a certain way because one is truly treated better when they are more attractive, skinny, etc. Eating disorders begin younger and younger.
AHH!! So many variables
Prejudice makes fools of everyone, including (especially?) professors.
I appreciate the urge to discount the results, or spin the results in the direction that fits one’s prior opinions, but this study gives us a certain degree of scientific rigor. Anecdotal evidence has a sample size of one, rendering it irrelevant when compared to a peer-reviewed, (presumably) repeatable, controlled study of 11,000 records.
No one is saying any particular woman is less tough than the average human, or, conversely, that any particular man is more tough. The results are the results. Namely:
“…researchers from the Stanford University School of Medicine recently analyzed the self-reported pain measurements from 11,000 medical records … women report greater levels of pain than men for the same injuries and ailments.”
I love your story about having your results dismissed because they did not match your teacher’s assumptions. What is the word for that – “confirmation bias?”
Maybe now someone will point out that “pain” is not a single entity. The pain of childbirth, after all, is carried to the brain by different nerves than the pain of a burn. Once there, it may be processed in a different way.
Does it make a difference how pain is incurred? If you tell the subject that he will get a prize for holding his hand in the water longer, or that someone will suffer if he doesn’t, does that make a difference?
So does this prove that women professors are stupider than male research assistants? I think so!
Dan, the article you linked to is
“IOM Report Calls for Cultural Transformation of Attitudes Toward Pain and Its Prevention and Management” and is more about the costs to society of inadequate pain management in patients.
It makes no mention of men or women experiencing pain differently. My guesses are you a) included the wrong link, b) they removed that information from the article, or c) you’re conducting a test on your readers to show 1) how powerful suggestion is or 2) people’s lack of incentive to follow links and examine the data.
I find the discussion between your previous professor and you unfortunate. It sounded more like a pissing contest of strength in the war of the sexes.
Her argument was inadequate as, were it to be true, women would eventually evolve not to experience pain at all during childbirth. Additionally, they would come not to report the process as painful.
I agree with her though on your study, given men and women’s acceptance of cultural norms where more men would be inclined (desire) to score higher on a test of endurance for threshold of pain – higher than their peers and higher than any previous performance. Another problem is that the hand exposure to extreme heat would have been better conducted by taking physiological readings for stress rather than when a subject decided to retract. The way it was administered makes it very unscientific.
But, we must also consider slight difference of body temperature between men and women and how they’d react to changes of external temperature. If you were to conduct this study, even without the proper equipment, you should have used a set of tests – including extreme cold and other stressful stimuli to the body.
And, since this was a test of performance, you’d have to figure out a way to control for people attempting to live up to expectations. See “stereotype threat.”
The results aren’t new though. Testosterone administered to men, women, and mice has increased the body’s threshold for pain. Conversely, increased estrogen has lowered the tolerance.
“Chronic Pain Conditions
What is the Role of Age and Gender in Pain?” (1998)
http://www.webmd.com/pain-management/guide/chronic-pain-conditions
“Why it hurts less to be a man
Testosterone damps pain sensation in males.” (2004)
http://www.bioedonline.org/news/news.cfm?art=1017
“Effect of testosterone on threshold of pain. [in rats]” (1981)
http://www.ncbi.nlm.nih.gov/pubmed/7341469
Anecdotally, a transgendered man undergoing testosterone treatment, reported experiencing less pain and sensitivity to his skin.
“Quite literally, I have toughened up. My pain threshold has increased. My skin is rougher, tougher, less sensitive. Before T[estosterone] I couldn’t tell the difference, but now when I touch my wife’s arm and then my own I’m amazed at how smooth and soft her skin is.”
“Sir, Can You Help Me With This?”
http://goodmenproject.com/featured-content/sir-can-you-help-me-with-this/
The evolutionary argument is that men had to deal with harsher environments when fighting and on the hunt.
There is, however, also conflicting evidence that estrogen treatment can increase one’s threshold for pain.
“Why Does Pain Tolerance Differ Among People?”
http://serendip.brynmawr.edu/exchange/node/342
Another point to consider in the Stanford study… women may report a higher level of pain in the hope that the doctor/s will take their complaints more seriously, since it has been reported in other studies that doctors sometime tend to “dismiss” women’s complaints as being more emotional rather than considering them to be actual serious problems (as in the diagnosis of heart attack). Another factor to consider is the presentation of symptoms and how they differ in the genders. Certainly, though, a fascinating study that possibly could impact the type of pain relieving drugs administered, dosages, and frequency of delivery depending upon whether the subject is male or female.
Hi Kay, I found this to be accurate and true. In most Pain Climics. It’s a muttidisiplinery approach. I’ve been battling very severe excruciating phantom pain that has effected every aspect of my life. I don’t think there is a single person in the world who could endure pain at this suicidal lecel non stop. I’ve had it over 15 yrs. I sat in the patient room on the table waiting EIGHT HOURS in agony to see the main doctor who was female in 2001. I had already waited over 2 months for the appt. The entire time, unrelenting, crushing, burning suicidal pain and she strolled in said UMM For what you have gone through. I believe you should see a psychiatrist 2x a week for the rest of your life. The tears began to flow. I hadn’t slept in 43 days. I was so jealous of the man checking out in front of me who had some sciatica. He a a load of powerful scripts. I decided to wheel my self over to the Dr. still in tears and said you may not have a clue when it comes to treating pain, but I won’t allow you to take my Hope away. Honestly It was the most inhumane year of my life. I’m fortunate to still be here. There is absolutely no way one can endure pain like that constantly. Every night you just watvh the clock while your spouse sleeps. Feeling envious of thier uncomplicated life. Truly if I hadn’t remained strong. That would have led me to taking my lie. You can read alittle about me above. So much more has happened then one ever realizes when going through 2 horrific catastrophic accidents.
Pain Relief as a Human Right
We must all die. But that I can save him from days of torture, that is what I
feel as my great and ever new privilege. Pain is a more terrible lord of mankind
than even death itself.
As a person who has described years of excruciating pain, I find your closing comment, “Pain Relief as a Human Right – Pain is a more terrible lord of mankind
than even death itself” a truth that you are more qualified to make than the person who has not experienced such pain. How many times have you heard people make comments like the following, in the hope of comforting a person who has just experienced the death of a significant other person…”At least his suffering is over”. This indicates to me that the fear of suffering for a loved one is worse that the fear of death.
In my limited experience with pain, if given a choice, I would choose a quick death over a prolonged period of suffering and I would imagine most people would choose the same. Hospice nurses often deal with terminal patients who choose drugs to keep them “comfortable” in their last days, but who do not want treatment to prolong their lives. So, in summary, I find myself agreeing with your point, but also recognize the problems associated with medical personnel trying to evaluate patients to help with pain relief. They all have probably experienced doctor-hoppers who exaggerate pain in the hope of obtaining drugs. It is a complicated issue, as are all. I appreciate the researchers, at least, trying to learn more about the issues. I’m afraid we have taken the original thoughts far afield, however, but your comments, as a sufferer, are important contributions to the thinking.
As anesthesiologists, we are trained to evaluate and treat pain as an individual experience irrespective of gender of course.
Even though I come accros often with “I am a woman, I endured childbirth and children therefore I have a high tolerance to pain” my observation is consistent with the Standford University Research findings. On average, men do better with pain.
There’s a hormonal effect, most often attributed to oxytocin, that causes women to have foggy memories of the pain of childbirth – something that makes sense from an evolutionary standpoint, given that if women remembered it clearly we would probably have a lot more one child families. I suspect the impact on memory affects later pain tolerance.
When I think back to when I was a child, I can think of traumas that were painful, agonizing, terrible, but that I would presently shrug off. Although certain factors can affect your pain tolerance, my impression is that on the whole the more physical pain you suffer during your life, the higher your eventual pain tolerance will be.
My grandmother washed dishes in extremely hot water, with no gloves, for her entire life. It left her hands desensitized to that type of pain. Had she participated in the aforementioned water study, she likely would have single-handedly (no pun intended) skewed the result. She might have commented, “I thought you said this water was hot.” I think it’s a matter of exposure, not gender.
There’s physical pain, emotional pain and mental pain. Male or female, we all have different tolerances to each. Men commit suicide at a higher rate than women, supposedly because women *fear* the pain of suicide more. Men have been conditioned to notice and dissociate from pain at an early age — something both men and women are capable of. To conduct a *true* experiment you’d need to experiment on babies, young infants preferably. But then you get into the question of brain synapses development and if, even at birth the female’s is more developed (it is) and thus women are far more likely to feel pain more. If women feel pain more, and I do believe they do because, across the board of human experience, they are also more sensitive in other ways as well. They perceive body language better, they see and respond to micro expressions better, they are more sensitive to sound, light and all matter of sensory input better. To say that they hurt more is to insinuate that’s a *bad* thing. It’s not. It’s different. If I want to weigh crates of turnips I use a truck scale.
I weigh myself on digital bathroom scales. Yet, If I wanted to measure the weight of a cluster of molecules, I’d use a zeptogram scale. Different measures for different things.
Men and women’s structures, brains, hormone makeup and DNA is different. You’re comparing apples and oranges, a typically male condition — as in, “Who would win a battle between Batman and Ironman?” http://everybodysucksbutus.com/2008/05/06/batman-vs-ironman-who-would-win/
Is there no way to monitor body/brain activity to at least record participant reactions to pain?
Asking someone if they are in pain and expecting them to rate their level of pain on a scale with no context seems pointless. They may not be truthful about when they feel pain, nor about the intensity of the pain.
I think what the paper proves is how men vs women are willing to describe their pain. It does not reflect actual pain tolerance, which I seriously doubt is gender specific.
To over generalize, men are taught not to show weakness in pain. Women are not taught that. Women are taught to vocalize their concerns about their own and other people’s pain.
That creates a confounding factor that makes the entire model of using a scale to describe pain rather useless even when considering large numbers.
And as you pointed out the model is very useless on an individual level because of immediate social factors. I don’t have a suggestion for a better solution for gauging a patient’s pain though.
“it’s likely that the large number of people included in the analysis counterbalances social and individual differences.”
That’s just misleading professor. You surely know it and I can only infer that you don’t care. Some people would prefer to be famous rather than right.
Dan, you would make a terrific troll. You don’t even try and yet you constantly troll more effectively than those who do it on purpose. Congratz
The link on your blog entry links to a press release that doesn’t talk anything about research.
Most important, I hope that medical providers will understand that gender *averages* are only that, and do not determine the pain experience of any individual patient.
Interesting post. Remembering back to my uni days, there was research comparing men and women exercising at the same work loads and they compared levels of perceived exertion… And woman reported significantly higher levels of perceived exertion than the men did.
In most intellectual areas, such as vocabulary and verbal reasoning, the differences between men and women are statistically insignificant. But the long tail of mathematical genius does tend to be male, along with higher rates of idiocy and stamina in exercise.
For over 30 years I have seen clients in my holistic medical clinic and in a private practice. After thousands of clients I can say without a doubt, men suffer more pain. Here’s the reason: we are tenser. When I have a tense female client, she suffer as much as a man.
“it’s likely that the large number of people included in the analysis counterbalances social and individual differences.”
Very disappointed in you Mr. Ariely – I am sure you know yourself that this statement is not true … or your desire to put your former professor in her place has clouded your judgement!
I don’t understand how you can draw any conclusions about the actual experience individuals have from the data. Pain is a personal experience. You might even suppose that women are hurt more quickly and intensely by hot water. We cannot experience someone else’s pain and therefore can make no judgement about their ability to endure that pain.
My thoughts on the pain scale are best summed up with this xkcd comic:
http://xkcd.com/883/
Be sure to mouse over the graphic for his additional comment.
http://hyperboleandahalf.blogspot.com.au/2010/02/boyfriend-doesnt-have-ebola-probably.html
Enough with the 1-10, 0-10 !!!
You know that ppl, cannot compute to that scale and have a tendency to rate with numbers higher than 5or6 due to the school grading system and it’s psychological effects.
1-3 or 1-5 is the max that ppl can compute.
and… whenever i read about another statistical human behavior test, i can’t help thinking about Nassim’s black swan theory.
Dash
Vago
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I saw an interesting experiment on TV where people were asked to hold their hands in freezing cold water for as long as possible… but in one case they had to remain silent, and in the other case they were to swear freely/constantly during the experience.
The same people could hold their hands in the water much longer if they were swearing and cursing away.
Childbirth is not a good comparison to gauge pain of men vs. women. It’s a natural process associated with a usually joyful event, verses breaking a leg in an accident.
This is very interesting!
What about childhood experience? I came from a long line of tough guys and son-prefered family. I’ve always wanted to be as tough as boys. I developed a relatively high tolerance for pain. I am often bleeding without knowing I’m hurt. It’s not that I don’t feel pain at all, but it would take a lot of pain to make me cry.
On the other hand, I noticed that girls who were raised to be girly girls are less likely to tolerate even a small scratch. Could pain tolerance also be a learned behavior? After all, when we’re experiencing pain, we are looking for empathy from others.
I was hit by a car in 1977. I was seven years old. Fast forward to the 1990′s I was ready to jump off a bridge from the pain. After a9hour spinal fusion surgery, then a cervical fusion and a morphine pump implanted my pain was at about a seven on the scale. Last December my pain increased past ten, I feel like my back is falling apart, and tomorrow my appt with a neurosurgeon will hopefully get to the bottom of this.
My pain each day now is above a nine, which means I am right on the edge of freaking out. As a man, I have learned to grin and bear it, but without opiate meds I would not make it, the pain consumes me, burning nerve pain, clamping vise pain on my guts, crushing collapsing pain in my low back, constant spasms in my neck and vomit causing migraines from it all. But I get by and try to do things each day, to thebest of my ability. Many people I know with pain issues gi be up, do nothing and suffer worse. I have death with pain, serious pain every day since the late 1970′s, but have still lived, sometimes better than others, but I have not given up, taken my place on the couch. I do know more women who Have let their pain get the best of them, although I do to know why that is. A few women close to me, with much less serious problems than I have, make. A much bigger deal of it. That’s my two cents for whatever it’s worth
I am surprised you were surprised. My daughter came home from school trumpeting the fact that women are blessed with more nerve receptors (for better or worse) hence often feel pain more acutely. It thus may not be fair to expect equal-opportunity maladies yield the same level of pain perception if women are indeed more physically sensitive.
Very interesting. Now I’m curious to see if this is due to culture or genetics.
I started reading your books looking for an answer to an issue that I’m dealing with in the campaign I run called The 50 Million Missing, on India’s female gendercide. What we repeatedly find is that regardless of how many thousands of women are murdered for dowry, their daughters killed before and after birth, women don’t want to get out of their violent marriages, even in cases where there are safer alternatives that they have (for e.g. their own jobs, house or money), because of the social stigma. And the violence in India is worse than in the west, because it is not one man beating up or trying to kill the women and girls, it’s he and his entire family!! What explains the pain threshold of Indian women? Do see our newspaper log here http://genderbytes.wordpress.com/news/
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