The researchers analyzed emergency department data and discharge notes of more than 21,000 patients presenting with pain complaints. This study provides a comprehensive analysis of archival datasets and a controlled experiment to test whether pain management decisions differ based on the patient's sex. 

The results found that female patients were less likely to be prescribed pain-relief medications compared to males, even when adjusting for reported pain scores and various patient, physician and emergency department variables. The disparity was observed across medical practitioners, regardless of gender. 

Further analyses indicated that female patients’ pain scores were 10% less likely to be recorded by nurses, and female patients spent an additional 30 minutes in the emergency department compared to male patients. A controlled experiment using clinical vignettes supports the hypothesis, showing that nurses (N = 109) perceive female patients' pain as less intense than that of male patients. 

The study’s findings highlight a significant under-treatment of female patients' pain, raising concerns about the societal and medical implications of overlooking female pain. The evidence demonstrates that physicians' and nurses' pain management decisions in emergency departments disadvantage female patients compared to male patients. The under-treatment of pain can negatively impact health. The findings underscore the need to address psychological biases in health care settings to ensure all patients receive fair and effective treatment. 

Co-authors on the study include Mika Guzikevits, Shoham Choshen-Hillel, Moses Shayo, Salomon Israel and Anat Perry of the Hebrew University of Jerusalem; Tom Gordon-Hecker of Ben-Gurion University of the Negev; David Rekhtman and Shaden Salameh of Hadassah Medical Center; David Gozal of the University of Missouri and Marshall University; and Alex Gileles-Hillel of Hebrew University of Jerusalem and Hadassah Medical Center. 

Funding for the study was made possible through grants from Israel Science Foundation grant (2824/22 to AGH and 354/21 to AP, SCH), Recanati Fund at the Hebrew University Business School at the Hebrew University (to SCH), Azrieli Fellowship of the Azrieli Foundation (to AP) and the National Institutes of Health (AG061824 to DG). 

To view “Sex Bias in Pain Management Decisions” in its entirety, please visit https://doi.org/10.1073/pnas.2401331121.