Quick Facts
According to several medical sources, including Pain Canada, chronic pain is any pain that lasts longer than 3 months and has a negative impact on a person’s daily life- One in four Canadians live with chronic pain
- Access to chronic pain care continues to be a challenge in Canada; improving access to chronic pain care is one of the top priorities identified by people living with pain
- A person’s experience with pain and the ability to find relief can be influenced by non-medical factors such as race and gender, making pain a social justice issue as much as it is a medical issue
- Pain is often misunderstood, mistreated, and mismanaged within the health care system; however, this is especially the case for marginalized groups, including women and gender diverse people
- Within the medical system, chronic pain is often poorly recognized; women and gender diverse people often report feeling their pain dismissed by health care providers; in the engagement for the Health Strategy for Women and Islanders who are Gender Diverse it was found that dismissal of pain was a key concern for many women and gender diverse people on PEI
- In Canada, 18% of women experience chronic pain, as compared with 14% of men
- Sex and gender minority persons report higher pain and experience unique life stressors (e.g. discrimination), which may lead to worsening of their pain
- BIPOC women especially report having their pain dismissed; some have experienced being discriminated against, stigmatized, and stereotyped as drug-seeking
The Longer Story
Pain Canada reports that eight million Canadians live with chronic pain (pain lasting longer than three months and is outside “standard” recovery rate for a particular injury or condition). That’s one in four people. Of that number, 18% are women (compared to 14% men). In a 2022 PRIDE study of over 5000 gender diverse participants, 54.6% of participants reported chronic pain. A 2020 study that involved over 2000 transgender individuals in Ontario found that transgender people are more likely to experience chronic health conditions (which includes pain).
While pain is often misunderstood, mistreated, and mismanaged within the health care system for people of all genders, this situation is particularly true for “people who have been historically, economically, and socially marginalized,” such as women, BIPOC individuals, and gender diverse people.
In a study published in International Journal for Equity in Health, 2SLGBTQIA+ participants reported being “disbelieved regarding the existence of pain, their level of pain and the cause of their pain, and dismissed regarding their concerns, needs and preferences, leading to ineffective health care…Overall, participants’ experiences of pain were deeply informed by a composite of experiences that included discrimination, stigma, dismissal and social and economic disadvantage as well as experiences of trauma.”
Origins of Pain
The path to finding relief for chronic pain can be long and complex. Some medical conditions that involve chronic pain affect more women than men (e.g., Multiple sclerosis, fibromyalgia, lupus, Ehlers-Danlos syndrome, rheumatoid arthritis, chronic fatigue syndrome), and these can be difficult to diagnose.
Additionally, pain can be caused by trauma, stress, and anxiety that can affect women and gender diverse people on a greater scale than cisgender men. A study published in the Journal of Pain Research found that gender identity may affect pain sensation more than genetic sex.
“The findings show that transgender women respond to painful stimuli similarly to cisgender women. Both groups of women show greater sensitivity than do men to repeated presentations of heat, and transgender women show the highest level of sensitivity to repeated mechanical stimuli.”
It’s important to recognize the intersectionality of this issue, as other factors such as race and economic status can also affect chronic pain. A person’s experience with pain and the ability to find relief can be influenced by non-medical factors, such as race and gender, making pain a social justice issue as much as it is a medical issue.
An article published in Pain: The Journal of the International Association for the Study of Pain states that:
“People who are Indigenous, recent immigrants or refugees, of colour, LGBTQ2S, less well educated, living with mental health or substance-use challenges, or have experienced violence and trauma, among others, are vulnerable to a higher prevalence of painful medical conditions, relative to nonmarginalized people, as well as to experiencing barriers to pain management services.”
In a 2021 study, researchers found that “all of the Indigenous participants described experiencing race-based discrimination, with most describing being constructed as ‘drug seeking’ by health care workers, regardless of whether they wanted medication or not.”
Black people and Black women in particular report having their pain minimized, often due to ignorance and a harmful stereotype about Black people not feeling certain types of pain and/or feeling less pain than white people.
BIPOC people and 2SLGBTQIA+ people report that seeking health care can be a barrier to finding relief for their pain, due to discrimination they experience from the health care system itself.
Intimate partner violence - something that women and gender diverse people experience more often than cisgender men - can also affect a person’s experience with chronic pain. In a study of almost 300 women who experienced intimate partner violence, “more than one-third experienced high disability pain.” This pain includes both areas associated with abuse and injuries as well as pain not localized to those sites.
Gender diverse people report higher levels of pain than their cisgender peers. They also report higher levels of discrimination, which can aggravate pain.
Diagnosis of Pain
Women and gender diverse people often report feeling like their pain is dismissed or minimized by their health care provider, which can make getting a diagnosis challenging. Gendered treatment (and bias) has been noted across various health care services, and the diagnosis of chronic pain is no different. Wellbeing of Women, a charity based in the United Kingdom, conducted a survey that found over half of women who responded reported having pain dismissed or minimized by a health care professional.
This discrepancy of pain treatment was explored in a March 2024 article published in eClinicalMedicine journal. Researchers noted that there are specific health conditions that affect women and some gender diverse people more than cisgender men:
“Women and girls are more likely to experience chronic pain conditions compared with men and boys and often report more severe pain and greater functional impairment. For example, migraine, musculoskeletal pain, temporomandibular disorder, fibromyalgia, rheumatoid and osteoarthritis, irritable bowel syndrome, and neuropathic pain are more common in women. Additionally, there are chronic pain conditions exclusive to women and people assigned female at birth, such as endometriosis, interstitial cystitis, vulvodynia, and pelvic girdle syndrome.”
The same researchers also found that women (and gender diverse people) often have a challenging time having their pain levels accurately believed:
“Women are more likely to encounter scepticism regarding the severity or legitimacy of their symptoms as a result of gender biases and cultural norms ingrained in the medical discourse about women’s bodies and diseases over centuries. These beliefs can contribute to health-care professionals downplaying or attributing women's pain to psychological factors or hormonal fluctuations rather than addressing its underlying medical conditions.”
In fact, some conditions that predominately affect women (e.g., fibromyalgia, chronic fatigue syndrome) were, until very recently, not even considered to be “real” illnesses by many primary health care providers. Why is there such bias against women and gender diverse people’s pain? Individual bias can play a role. In a study published in The Journal of Pain, researchers found that women’s pain was more likely to be underestimated by others than men’s pain. Women themselves often feel the need to downplay pain symptoms due to societal messaging for women to prioritize their own needs last.
Additionally, medical professionals report having little to no training on factors that can cause pain in the 2SLGBTQIA+ community, for example, the impact of binding, tucking, and hormone replacement therapy on pain levels of transgender individuals. Since many transgender people report discrimination in the health care system, many transgender people might avoid seeking medical help for chronic pain.
Some medical conditions that involve chronic pain and that affect women more than men also can be difficult to diagnosis, which can leave the person experiencing the pain feeling frustrated.
Treatment of Pain
Specific treatments for pain relief can often be influenced by gender. Studies show that when men and women/gender diverse people show similar pain symptoms, men are more likely to be prescribed medication while women/gender diverse people are more likely to be offered psychotherapy.
Change starts with the health care system placing more of an importance on learning about gender bias and being aware of its existence. Language around certain medical conditions can cause assumptions. For example, the way the medical profession speaks about endometriosis is often gendered, with the underlying assumption that it only affects cisgender women. The reality is that, while endometriosis is more common in women, it can affect any gender. Hearing a health care provider use limiting language regarding the condition could dissuade gender diverse people from seeking care.
In 2021, the Canadian Pain Task Force released the Action Plan for Pain in Canada. One of the six goals outlined in the Plan includes “improved and equitable access to services for populations disproportionately impacted by pain.” The Plan goes on to specify recommendations for supporting care of women and gender diverse individuals.
PEI Resources
Individuals experiencing chronic pain should first seek treatment from a primary health provider. For Islanders who do not have a primary health care provider, walk-in clinics or the primary care access clinics are available.
Additionally, the Provincial Pain Clinic is available to access; however, a referral is needed from a primary health care provider.
Individuals who have been diagnosed with either unexplained chronic pain, are currently seeking a diagnosis, or who have received a diagnosis that comes with pain symptoms might be able to find relief from supplementary treatment (e.g., physiotherapy, orthopedic clinics, acupressure, massage).
Some people may also find relief from mobility and/or exercise programs.
Peer support can often be found by seeking out groups associated with a particular illness or condition (e.g., Crohn’s and Colitis PEI).
National Resources
A few National Resources available include:
- Power Over Pain Portal is a free online resource for people who live with pain
- Pain U Online includes modules to help manage pain, provided by Toronto Academic Pain Medicine Institute (TAPMI)
- LivePlanBe+ is a free online course with over 23 self-paced modules covering over 40 topics
- Pain Canada includes resources and links to pain information, support and research
Sources
About chronic pain. Government of Canada.
Canadian Pain Task Force. (2020). Working together to better understand, prevent, and manage chronic pain: What we heard. Government of Canada. [PDF]
Darnall, B. D., Sturgeon, J. A., Kao, M. C., Hah, J. M., Cook, K. F., Roye, G. D., ... & Mackey, S. C. (2022). Patient-reported outcomes for chronic pain in the learning health system. Pain Medicine, 23(2), 215-228.
Funk, C., & Hefferon, M. (2022). Black Americans’ views of and engagement with science. Pew Research Center.
International Association for the Study of Pain. (2022). Classification of chronic pain for the International Classification of Diseases (ICD-11). Pain, 163(2), 215-221.
JAMA Network Open. (2020). Pain in persons who are marginalized by social determinants of health. JAMA Network Open, 3(2), e2019403.
Johnson, J. L., Greaves, L., & Repta, R. (2023). Sex and gender are not the same: Why identity is important for people. Journal of Pain Research, 16, 351-362.
Nahin, R. L., & Fitzcharles, M. A. (2021). Pain management in marginalized populations. Journal of Pain, 22(4), 351-360.
Ospina Medical. (n.d.). Chronic pain management in trans individuals: Overcoming unique challenges.
Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). "Brave Men" and "Emotional Women": A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Research and Management, 2018, 6358624.
Vang, Z. M., Ostbye, T., Puri, P., & McDonald, J. T. (2021). Exploring chronic pain prevalence and healthcare among sex and gender minorities. International Journal for Equity in Health, 20, 94.
Wager, E., & Kleinert, S. (2024). Chronic pain management: Evolving paradigms. EClinicalMedicine, 30, 100137.
Ware, M. A., & Fitzcharles, M. A. (2008). Chronic pain management in Canada. Journal of Pain, 9(6), 478-485.
Wong, S. K., & Lam, C. L. (2021). Chronic pain and healthcare utilization in Hong Kong: A population-based survey. BMC Family Practice, 22, 124.
Published date: August 2024
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