Health & Harmony
By Dr. Nancy Gahles, DC, CCH, OIM
Women in Pain
“There seems to be an ‘Oh she’s so neurotic’ attitude towards female chronic pain patients,” is how one woman described her experience with the healthcare system.
“I have seen many doctors...for my back pain and migraines and find that many of those doctors treat women as simple or stupid and direct questions or directions to male partners or friends,” wrote another woman. These are responses from an online survey
conducted by National Pain Report and For Grace, a non-profit foundation.
According to their survey, over 90% of women with chronic pain feel the healthcare system discriminates against female patients. The survey found that 84% feel they have been treated differently by doctors because of their sex and 65% feel doctors take them less seriously because they are females.
Chronic pain conditions in women, more often than not, are multifactorial in expression.
The National Pain Report adds comments like these from the survey:
“In addition to fibromyalgia and problems with both hips and lower back, I have severe Sjogren’s syndrome. Additionally, I have been diagnosed with a very rare optic neuropathy.”
“Central pain syndrome from nerve damage, occipital neuralgia, brachial neuralgia. Broken heart from loss of loved career and inability to help with adopted grandson with disabilities,” reads like a page from the playbook of my 37 year career as a chiropractor.
Pain that becomes chronic, that is, lasts for more than 12 weeks, gradually entrains the nervous system and destabilizes the entire network system. While we, as humans, are adaptive network systems, as Dr. Iris Bell, so eloquently pointed out in her research, there is a point at which adaptation fails. This is the chronic pain dilemma that confronts and confounds us as practitioners.
To tease out all the components of each person’s state of pain is generally beyond the scope of a single practitioner. Integrative practitioners have some advantage in that they are either educated in one or more of the alternative disciplines that have a complementary effect with their own or they are knowledgeable enough to join a team effort. In my integrative practice, I would address the central pain syndrome from nerve damage, occipital and brachial neuralgias from a chiropractic perspective. I would address the broken heart and loss syndrome from a homeopathic perspective and the feelings associated with being unable to help with her grandson with a team approach inclusive of Cognitive Behavioral Therapy (CBT) and positive emotion psychology, Mindfulness Based Stress Reduction(MBSR) and QiGong. It is understood within the faith-based healing ministries that finding , developing and maintaining meaning and purpose in one’ life contributes greatly to reduction of pain. It has been my experience that patient focused therapeutic intervention, one that involves the person as a partner in their own care, is the most effective.
Narrative medicine, or just plain listening with an open heart and mind to the story of the person suffering will go a long way to encourage trust and compliance and to eliminate the feeling of gender bias.
Beth Darnell, PhD, a pain psychologist, notes in the National Pain Report, the complexity of conditions that are interwoven in body/mind/spirit, such as fibromyalgia. The most common condition (60%) reported in the survey was fibromyalgia wherein the women said they had multiple chronic pain conditions, making diagnosis and treatment more difficult. Of the 58% of those reporting fibromyalgia, 60% of the women said they were currently using a narcotic painkiller. Dr. Darnell said, “Not only is that number high, but opioids don’t help fibromyalgia. In fact, there’s research to show that it actually makes it worse.”
One of several compelling research studies by Dr. Bell offers consideration of individualized homeopathic remedies in the treatment of fibromyalgia. The individualization of treatment goes back to the narrative, the patient’s story. And it speaks to eliminating bias. First do no harm. Consider all options that may fit the case of the person presenting to you. Male or female. Women consult doctors more frequently than men for pain conditions. They are more likely to tell you ALL of their symptoms which can cause eye rolling and exasperation on the part of the doctor who has seven minutes to meet you, examine you, render a diagnosis that fits a compensable ICD-10 code within his/her specialty. It is easy to see why women in pain can feel marginalized or discriminated against. There is no strategy in our current healthcare system for individualized treatment of people suffering with chronic pain.
Women’s experience of pain counts. Perhaps it is the sensitivity of women that offers the dual edged sword of being sensitive to pain and becoming centrally sensitized to pain that brings them to the doctor’s office for help. Chronic pain is felt systemically, it interferes with every area of life and it is stigmatized, especially to women. Steve Passik, PhD, a psychologist and VP of Research and Advocacy for Millenium Health, responded thus to the survey, “I think the experiences of women in pain need to come out in the open and really need to be publicized. This is a wake-up call for people who take care of women in pain.” (Reprint from my article in IP.com)
Rockaway residents can be assured that there is a safe place for them to tell their story and receive skillful solutions at Health & Harmony Wellness Center. I have been taking care of women in pain for over 37 years. Every woman’s story matters and every woman’s story is truth.
Be mindful that the perceptive “end” of summer and the approaching hurricane season wreak havoc on those who are at risk for or suffering from PTSD. Studies show that watching a traumatic event repeatedly brings on the exact same experience as if you were there. I do NOT recommend that you watch the news of Hurricane Harvey constantly.
Following that will be the season of Autumn wherein heart attacks and death is highest. Then will be the holidays fraught with grief and loss and often chaotic relationship issues. These are trigger times for women in pain. Often, we are not aware of these triggers, the environment or even our own thoughts and beliefs surrounding the pain we feel.
PTSD is not only a psychological experience of anxiety but a manifestation of a traumatic experience in the body, emotions and spirit.
Many painful conditions such as fibromyalgia, chronic fatigue syndrome, cardiovascular disease, musculoskeletal pain are associated with PTSD.
PTSD can also be a result of caregiving for dying loved ones. It is also a feature of BurnOut Syndrome. Women in pain are notorious for discounting the effects of overachievement, “chronic caregiving” and the expectations of family and employers of the woman who can do it all. In fact, we wear it as a badge of honor. It deems us “good enough”. Fatigue and back pain have long been considered a “natural” fact of life for women. We do it all and we get tired and our back aches. So what? NOT so! Women are not supposed to work to the point of exhaustion, mentally, physically or emotionally.
The evidence-based research tells us that Mindfulness Based Stress Reduction (MBSR) programs of 8 weeks length do have a mitigating effect on PTSD, emotional trauma of any origin and physical pain. The same is true for whole medicine systems like homeopathy, chiropractic, acupuncture and for the compassion based practices such as the Loving-Kindness meditation. Taken together, we have tools and skill sets that will sustain us and build resilience and self worth. It is in the listening to the story and the unravelling of the tale that brings us back to our source energy and from there the reclaiming of our Self.
In addition to the integrative and holistic services Health & Harmony hosts an
ongoing compassionate community of spiritual support at Spirit of Love~The Rockaway Sangha. The practice of “tend and befriend” echoes the resources of ages, that is, people, women in general, gathering together with a purpose that gives meaning to all our lives. Tending and befriending decreases the stress hormones and increases the bonding hormones which reduce pain. As my Dad always told us, being part of a large family: “There is strength in numbers.”
May The Blessings Be!
Rev. Dr. Nancy Gahles is founder and owner of Health & Harmony Wellness Center and Spirit of Love~The Rockaway Sangha. She has been in family practice in Rockaway since 1988 as an integrative and holistic doctor and Ordained Interfaith Minister. Visit her at :http;//www.drnancygahles.com