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Fibromyalgia: Gender Discrimination and Fibro Pain

Let me start with a fact that many doctors acknowledge but prefer not to discuss: Numerous well-conducted studies have shown that all chronic pain patients, but especially women, are seriously undertreated by physicians.

This can be any type of chronic pain–from fibromyalgia, arthritis, cancer, an autoimmune disorder like lupus, anything. If you’re a woman, expect to get short shrift from your doctor–male or female–when it comes to pain control.

Are the reasons for this rooted in a heritage that (wrongly, in this case) admires stoicism? Whatever the cause, too many physicians feel annoyed by the chronic pain patient, quickly labeling her as “needy” or a “hypochondriac,” especially if she has fibro with its raft of negative tests.

Young girls probably pick up on this minimizing of pain early in life. Her sports injury couldn’t possibly be as painful as her brother’s, because, well, she didn’t (shouldn’t?) play as hard. Painful menstrual cramps are another example. Teenage girls regularly faint from them, but often hear “Take a Midol and get used to it.”

The irony is that women are generally more articulate about their symptoms than men, willing to discuss pain with a sympathetic physician who might offer relief. Too frequently, though, women in pain leave the doctor’s office with a sense that wherever the pain is coming from, they’re going to have to learn to live with it.

With this pervasive gender prejudice, you can bet getting adequate pain relief for fibromyalgia (affecting females 95% of the time) is extremely rare. Remember, because fibro falls under the radar screen of diagnostic tests, the vast majority of doctors will not write a decent pain medication prescription for this “non-disease.”

So what kind of treatment can one of the roughly 20 million fibromyalgia patients expect to receive when, after seeing the (statistically-based average of) five physicians who “don’t know what’s wrong” with her, finally finds one who actually diagnoses her fibro?

Disappointment.

The average fibromyalgia patient is kept on an astonishing number of prescription drugs–usually about five–and amazingly enough, not one of these is an actual pain medication.

Five individual prescriptions is a huge number. A doctor can bring high blood pressure under control with one, perhaps two, pills a day. High cholesterol? One. Fibro, five. Why so many? Because he’s treating symptoms, not any specific illness, and fibro brings with it a multitude of symptoms.

But what about the ads you see on TV for fibro pain medications, such as Lyrica? These aren’t actually pain meds (you wouldn’t take Lyrica for a toothache), but various chemicals with many effects on the body (both good and bad), one of which can reduce fibro pain somewhat. If the good effects outweigh the bad, you might feel a little better.

On the other hand, a true pain med (an analgesic) stops pain in its tracks, whether the pain is from an abscessed tooth, cancer, a migraine, or fibro. And this is the one type of medication a fibro patient usually doesn’t receive.

Next week we’ll talk about why this is so, along with those five fibromyalgia prescriptions patients do get.

In the meantime, learn about the organization For Grace, founded by a badly injured former dancer, Cynthia Toussaint, who writes:

“…my doctors completely ignored my symptoms. For the next 13 years, they told me my condition was ‘all in my head’ while the disease with no name mercilessly spread throughout my entire body.”

She realized how poorly women in pain were served by physicians and set about to increase the awareness of the public, physicians, politicians, and health insurers. A good person, Cynthia. Tough, despite her relentless pain.

Click here for Part 5.

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7 Comments


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  1. Mary Hall says:
    June 8, 2010 at 8:19 am

    Boy, this is just a ray of sunshine….

    M.

  2. Mary Hall says:
    June 10, 2010 at 12:15 pm

    Dr.,

    Medical marijuana has been in the news a lot lately. Has this remedy been evaluated for success with Fibro pain? What is the prevailing opinion?

    Thanks.

    M.

  3. paulrubin says:
    June 11, 2010 at 8:59 am

    It has not been adequately tested but knowing that fibro is a reaction of the muscles to stress and marijuana reduces the sense of stress, it probably works quite well.

  4. marylou carroll says:
    June 15, 2010 at 6:29 am

    The entire fibro series has been invaluable. Thank you.

  5. Mindi Anderson says:
    August 16, 2010 at 8:16 am

    This series has been eye-opening for me. I nearly wept when I read the symptoms I have been experiencing are those of fibro. I’m not crazy. Thanks so much!!!

  6. wandering through says:
    August 29, 2010 at 7:31 pm

    It makes no difference whether the pain is from fibro or cancer, pain medication is routinely under-prescribed. Gender discrimination is real, but the doctor fails to point out that one of the major reasons for under-prescription of pain medications is fear of reprisal by the DEA. Doctors specializing in pain management/relief have been tried and convicted to lengthy jail terms for prescribing adequate pain medication. This over-zealous prosecution of the misguided “war on drugs” is at least as much to blame as any perception that women’s pain just doesn’t matter.

  7. Aloka Dalal says:
    April 25, 2011 at 8:42 pm

    Women’s health was always on the “back burners” of medicine. We have been told to “grin and bear”it. Our bodies are physiologically made to endure more pain than an man (childbirth) but that should not eliminate the fact we do feel pain. Whether it is the Industrialized west or the third world East, we ignore our female patients and try to trivialize their problems into categories of “hypochrondria/menopause/avoidance of work/attentionseeking” .Some of my medical professors taught us to look “deeper” into a complaint made by women and indirectly suggesting that it may be psychosomatic in nature. Also through their actions their attitude they condoned the difference in treatment of women. From doctors to insurance companies they want to make sure that women get the short end of the stick.