On the contextuality of gender biases in pain care: Theory and evidence

Abstract

Pain is a universal human experience and the most common reason to seek medical care. Although women report more frequent and disabling pains than men, their pains are more often underassessed and undertreated in clinical encounters. Understanding the ‘whens’ and ‘whys’ of this gender paradox is vital to promote pain care equity and efficiency. Yet, the atheoretical and descriptive nature of most studies on provider gender biases in pain care is stalling the research field. To overcome this gap, we first propose the novel Gender Biases in Pain Care Model, which conceptualises the contextual nature of gender biases in pain care. It is an interaction-based socioecological model that integrates assumptions of gender-related theories and dual process models of person perception and stereotyping. Second, we conduct a theory-driven review of current evidence addressing the model's theoretical contentions. Sixty-six articles (8 reviews and 58 primary studies), mostly published in 2010–2024, were included. Although findings provide preliminary support for the model’s four contentions, important empirical gaps are still unaddressed. We discuss how this model is a steppingstone to the generation of novel research questions and testable hypotheses that may fill current knowledge gaps and contribute to the development of equitable pain practices and policies.