The intersectionality of chronic pain

100 million adults in the United States have chronic pain conditions. Women are overrepresented in their number. Women of colour, even more so. There’s a tangled thread of circumstances that creates these imbalances, and it loops around to another problem: Intersectional oppression in the treatment of chronic pain, both medically and socially. Deep-seated social attitudes about pain, how people manage it, how people should manage it, and the kinds of people who experience chronic pain play key roles in how people living with conditions like fibromyalgia are perceived, and the results aren’t pretty.

Why do women experience pain more than men? This actually isn’t entirely well understood, although some gendered differences may have to do with genetics — cis women appear more pain-sensitive, for example. (Naturally, there’s little to no information on the trans community, and as usual in medical research, much of the data available revolves around studies conducted on middle-aged white men, who are treated as a ‘model’ or ‘universal’ patient, a particular problem with gendered conditions like pain.) What we do know is that in terms of the experience of pain, there’s a clear and very gendered divide.

That’s exacerbated by race, for a number of complicated reasons. One is very simple: Women of colour are more likely to work in professions that can expose them to an increased risk of occupational injuries associated with chronic pain. For example, the majority of housekeepers, private and professional, are women of colour, and housekeeping can cause long-term health problems as a result of strain. Women may be forced into retirement by back and shoulder issues, or could experience chronic pain throughout their careers and into retirement. Likewise, women of colour are more likely to work in the fields, and to perform a variety of other menial labour.

The perception of how women of colour interact with pain is also highly damaging. While women in general often find their pain dismissed as psychosomatic, unimportant, and not as real as men’s pain, women of colour are in an even more unpleasant position. Racist attitudes suggest that they don’t experience pain in the same way other women do, for example, a throwback to very old attitudes indeed about slavery and the value of Black and brown lives. While health care practitioners and members of society in general might not explicitly state that they think women of colour experience pain differently, they definitely act that way, demanding that they tough it out and putting heavy expectations on women of colour to work through pain.

These attitudes compound with the belief that women of colour are drug seekers bent on getting high at every opportunity. Many pain management medications are related to drugs used recreationally, and some have dual-purpose uses, which presents a problem for all chronic pain patients, but especially those of colour. When you need medication that other people associate with getting high, and social attitudes suggest that you’re a bad social element, you’re going to have trouble accessing those medications, because people don’t understand how they work and how they’re used.

A Black woman who takes percocet to help her manage breakthrough pain is not the same as a white woman who takes the same drug for recreational uses. In an ideal world, either use wouldn’t matter, but it’s still important to separate medical and recreational uses of medications. Chronic pain patients need a reliable and safe supply of medications to keep them comfortable and manage their pain effectively, as the best pain care is that which keeps levels low consistently, rather than allowing pain to repeatedly stress the body by peaking and spiking. In addition to maintenance pain medications, they may need heavy-duty breakthrough pain management, all of which should be readily accessible so they don’t have to struggle with a doctor when they’re dealing with the stress of pain. They definitely don’t get high from medications like vicodin.

But because we stigmatise drug users, we punish chronic pain patients. Because we insist that chronic pain patients are drug seekers, especially if they are women of colour, we sentence women of colour to needless suffering that could be mitigated or alleviated altogether. Consistent pain management can radically improve quality of life, and yet it’s repeatedly denied on the grounds that we must protect society from the scourge of drug users. Even the reality of life on chronic pain medications — like the need to continue taking the medication in order to remain comfortable, and the risk of painful withdrawal if the medication is abruptly suspended — is erased in the interest of building up a dangerous mythology around them.

When we talk about intersectionality, this is one of the things we need. Social movements that purport to be about women should be concerned about chronic pain and its disproportionate impact on women, and should be pushing for a focus on researching the subject, studying why it appears more in women, and developing better pain management tools. (Some of the medications used today haven’t changed much in the last millenium.) And it’s even more troubling that there’s a highly racialised element to chronic pain management that also isn’t being addressed — what does it say about social movements that they ignore disability in the first place, let alone that they ignore such a clearly intersectional incidence of social injustice?

Image: Eros Galicia, Dani_vr, Flickr