Scratching the Surface:Misrepresentation in Chronic Pain

Writen By: Allie Milot

Turn on the TV, open up YouTube, watch almost any advertisement that addresses chronic pain and who do we see? A man, particularly a caucasian, middle-aged, upper class man. Although these advertisements are not representing false information, they are simply leaving out the larger truth: the chronic pain community is full of men and women of all ethnicities.

Looking into an in-depth study that has been conducted by researchers from the Department of Sociology at the University at Buffalo, State University of New York we see that there are some serious sociodemographic disparities in chronic pain. One example of this is that “higher income individuals report pain less often than lower income individuals”. (Grol-Prokopczyk, 2017). This is only a single fact from the entire study that observes the differences between people with chronic pain depending on the sociodemographic group into which they fall.

There are also findings from a study conducted at the University of Florida that reveal gender differences when it comes to chronic pain. For example, “women exhibit greater pain sensitivity, enhanced pain facilitation and reduced pain inhibition compared with men” (Bartley and Fillingim, 2013). Although the results shared here will only scratch the surface of the realities that exist in the chronic pain community, we’ll begin with gender differences in chronic pain and move our way into broader groups of people that make up the 50 million chronic pain sufferers in the United States today (CDC, 2016).

In 2013 a study was done by the Pain Research and Intervention Center of Excellence at the University of Florida on the pain prevalence and tolerance for both men and women. Although men are often thought to experience chronic pain more prominently, given what the media has produced over the years, this thought is incorrect. Research shows that women consistently demonstrate greater pain prevalence in their lives relative to men (Bartley and Fillingim, 2013). Women are also more likely to report instances of pain as well.

This may be a result of cultural norms that have been created by our society often known as the “brave man” who does not admit his pain and the “emotional woman” that is willing and open about her pain (Samulowitz et al, 2018). Regardless of people's mindsets, the truth still remains that women are more likely to develop various chronic pain conditions throughout their lives. Fibromyalgia, migraine and chronic tension-type headache, irritable bowel syndrome, temporomandibular disorders, and interstitial cystitis are all examples of conditions that women have a greater risk of developing.

While our understanding around gender differences in chronic pain continues to evolve, sociodemographic differences in the chronic pain community are equally as important. The study conducted by researchers at the University at Buffalo affirms the fact that women experience higher rates of pain, however it quickly moves into findings that examine various ethnic and social groups who experience chronic pain.

This study examined Americans that were between the ages of 51 to 80+ years old**. The study split these participants into 6 different categories. Pain status by

  1. Gender: As stated above, it was found that over the course of the 12 years, both men and women experienced an increase in pain, as is most common for people that battle chronic pain. However, women reported a much higher pain score consistently throughout the study period.

  2. Education: For the entire group of participants, the results of the study showed that people without a degree, high school or college, reported the highest pain score. On the other hand, people with a graduate degree reported lower pain scores, almost twice as low at the non-degree participants.

  3. Wealth: Those who are considered “poor” had the highest pain scores, while the wealthiest participants had a 78% lower pain score than their “poor” counterparts.

  4. Race/Ethnicity: Although these pain scores were closely clustered together, hispanic participants were among the higher reporters of pain, followed by black, with caucasians having the next lowest pain scores and other (non-hispanic) people having the lowest reported pain scores.

  5. Age Baseline: Since there was a large range of ages that were observed during this study, the 80+ year old baseline group resulted in a higher pain score over time while the 51-59 year old baseline group had the lowest scores. It was also found that chronic pain seemed to plateau for people in their 60s with a potential spike in their 80s.

  6. Survival Status: This section of participants was split into two groups: decedents and survivors throughout the 12-year study period. A large and consistent result shows that decedents had, on average, 31% higher period scores.

All six of these categories are necessary to reveal the differences that exist between members of the chronic pain community. We do not all look the same, work the same way, or have similar backgrounds. However, our common thread is the everyday battle with chronic pain.

If you suffer from chronic pain and do not identify with the groups that are represented in the media today, remember that you are not alone. Just because the face you see on TV or online doesn’t match your own, does not mean that you are the only one suffering. There is a large community surrounding you - 50 million strong - pushing for proper resources and care.

Chronic pain is a personal journey full of individual challenges. We realize this article just scratches the surface of what patients, clinicians, and researchers are confronted with.

Our goal is to help shine a light on the inequities of pain care so we may be able to fix it. Often simple steps can be taken to move the ball forward including the use of inclusive pain measures and believing the patient.

With the vast majority of patients being those 51+ in age it seemed fitting to start there. (CDC, 2016) We hope you enjoyed this first attempt at a heavy topic and will join us for our other articles.
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References

Grol-Prokopczyk, H. (2017, February). Sociodemographic disparities in chronic pain, based on 12-year longitudinal data.

Retrieved July 14, 2020, fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242384/

Bartley, E., & Fillingim, R. (2013, July). Sex differences in pain: A brief review of clinical and experimental findings.

Retrieved July 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690315/

Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006.

DOI: http://dx.doi.org/10.15585/mmwr.mm6736a2externalicon

Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018, February 25). "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain.

Retrieved July 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/

RMinemyer, P. (2018, September 17). CDC: 1 in 5 Americans suffer from chronic pain.

Retrieved July 14, 2020, from https://www.fiercehealthcare.com/hospitals-health-systems/centers-for-disease-control-and-prevention-chronic-pain-opioids