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Rethinking Pain Scales for Women in the Context of #MeToo

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Editor’s Note: If you’ve experienced sexual abuse or assault, the following post could be potentially triggering. You can contact the National Sexual Assault Telephone Hotline at 1-800-656-4673.

“What would you rate your pain?” I have had to answer this question more times than I can count in the last couple of months as I have coped with acute onset flank pain with an unknown cause. I have been to the ER multiple times, hospitalized twice, had countless tests (including going to the Mayo Clinic for two weeks) in an effort to find the “smoking gun.” To date, we have yet to discover a cause.

As I have walked this diagnostic road, I have been asked over and over again to rate my pain. This is always a difficult task. First of all, I look totally normal and calm, even when I am in excruciating pain, so the “smiley face” pain scale doesn’t help much. If I go with a 10 being “worst pain imaginable,” then I at least have something solid. For me, then, a level 10 is childbirth.

Lately I have been at a level 8-10+ when the pain is not managed, and I am not a person who is dramatic about pain. In fact, I am very quiet. I have often felt I would make more sense to physicians if I cried, screamed and rolled around – but that’s just not how I respond to pain.

Furthermore, how do I explain my level 10 to a male physician? He has never experienced childbirth – therefore he cannot fathom the amount of pain I am using for comparison. It is a unique pain. The entire time I was in labor, I was quiet. I meditated through four-minute contractions when my epidural failed. That’s when I learned I am a person who is capable of handling a great deal of pain… and I don’t necessarily respond in the familiar way.

Just last week I went to the ER with pain that was well beyond what I experienced in childbirth – the pain of adrenal crisis. By the time I got to the emergency room, I had already injected the requisite amount of steroid per the adrenal crisis protocol, and I simply needed to be checked out to ensure my electrolytes were in balance and there wasn’t anything else going on, as I had just completed a three-day infusion of prednisone at the Mayo Clinic. Internal bleeding was a possibility, so off to the ER I went. The ER physician asked, “How would you rate your pain?” I quietly answered, “10.”  Truthfully, I don’t think he believed me.

So this brings me to the contemporary context of #metoo. There seems to be a gaping hole in medicine that deserves attention: I believe that many women interpret pain scales differently than men. I also believe that many women tolerate a great deal more pain before seeking help. Let’s face it, our bodies begin to experience the pain of menstruation from the time we are teens… we birth children… and many of us have survived the pain of sexual abuse and sexual assault, which can sometimes cause us to learn how to disassociate from pain.

On this latter point, it took me years in therapy to realize my ability to disassociate is actually a useful skill in managing pain. I can walk around appearing normal while enduring significant pain. In fact, there was a time I gave an entire C-Level lecture at a national conference while having a gall bladder attack. How would I rate my pain then? It didn’t matter – I had a lecture to give.

So here’s my question: Has the medical community researched the unique ways many women may interpret pain? I don’t know. What I do know is there has been a lot of focus on the idea that sexual abuse and assault can sensitize a person to pain (I hear this often from doctors – that I must be extra sensitive because of my abuse history). It got me thinking, though, what about the opposite? What about women having the ability to endure extraordinarily more pain as a result of the resilience formed through traumatic experience? In my case – as a rape survivor – my ability to disassociate can be a positive when learning to manage pain in my body. It was helpful to see the ways in which negative patterns can be transformed into positive attributes.

So today, when I say I am in pain – I mean it!

Perhaps the medical community can learn to take the unique experiences of women into consideration when addressing the issue of pain. Rather than minimizing our concerns by suggesting we have been overly sensitized, I would suggest that physicians should consider the possibility that women are capable of handling excruciating pain in the course of everyday life – so much so that it often goes unreported and unmanaged.  I would further argue that physicians should consider the fact that by the time we make it to the doctor’s office or the emergency room for help, it’s because the pain has exceeded our ability to manage it on our own.

Rather than minimize women’s experiences by labeling us as “sensitive” or “dramatic,” perhaps the medical community can notice how many of us have endured painful experiences like birthing children or surviving the pain of assault – and instead respond with an attitude of: “Wow, if you are saying you are hurting… I believe you.”

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Thinkstock photo via samotrebizan.

Originally published: October 19, 2017
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