Gender Biases in Estimation of Others' Pain

Abstract

Caregiving and other interpersonal interactions often require accurate perception of others' pain from nonverbal cues, but perceivers may be subject to systematic biases based on gender, race, and other contextual factors. Such biases could contribute to systematic under-recognition and undertreatment of pain. In 2 experiments, we studied the impact of perceived patient sex on lay perceivers' pain estimates and treatment recommendations. In Experiment 1 (N = 50), perceivers viewed facial video clips of female and male patients in chronic shoulder pain and estimated patients' pain intensity. Multi-level linear modeling revealed that perceivers under-estimated female patients' pain compared with male patients, after controlling for patients' self-reported pain and pain facial expressiveness. Experiment 2 (N = 200) replicated these findings, and additionally found that 1) perceivers' pain-related gender stereotypes, specifically beliefs about typical women's vs. men's willingness to express pain, predicted pain estimation biases; and 2) perceivers judged female patients as relatively more likely to benefit from psychotherapy, whereas male patients were judged to benefit more from pain medicine. In both experiments, the gender bias effect size was on average 2.45 points on a 0-100 pain scale. Gender biases in pain estimation may be an obstacle to effective pain care, and experimental approaches to characterizing biases, such as the one we tested here, could inform the development of interventions to reduce such biases. Perspective: This study identifies a bias towards underestimation of pain in female patients, which is related to gender stereotypes. The findings suggest caregivers' or even clinicians' pain stereotypes are a potential target for intervention.

Keywords: Sex; gender bias; pain estimation; pain treatment recommendations; pain-related gender role expectation; stereotypes.

Fig. 1.

Gap in pain estimates at the same pain cues in Experiment 1. The y axis shows residuals in perceivers’ pain estimates on a 0–100 scale when controlling for patients’ pain facial expressiveness and self-reported pain. The error bars reflect the within-subject standard error of the mean.

Fig. 2.

Gap in pain estimates at the same pain cues in Experiment 2. The y axis shows residuals in pain estimates on a 0–100 scale when controlling for pain facial expressiveness and self-reported pain, grouped by gender. Error bars show within-subject standard error of the mean.

Fig. 3.

Pain treatment preference for psychotherapy vs. medication for male and female patients. Y axis values represent the proportion of the patients of a given gender in which perceivers indicated psychotherapy would be more helpful than pain medication in a forced-choice test. Proportion of pain medicine = 1- proportion of psychotherapy. Psychotherapy was preferred more often for female than for male patients whereas pain medication was preferred more often for male than female patients. Error bars reflect the standard error of the mean. *, p < 0.05.