The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions

J Pain. 2014 May;15(5):551-9. doi: 10.1016/j.jpain.2014.02.003. Epub 2014 Feb 24.


Research suggests that patient sex, provider sex, and providers' sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers' sexist attitudes were associated with these differences. Ninety-eight health care providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F[1, 96] = 4.51, P < .05, ηp(2) = .05) and mental health referral (F[1, 96] = 3.89, P = .05, ηp(2) = .04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers' sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than for male pain patients, and providers' sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities.

Perspective: The results of this study suggest that patient and provider sex, but not providers' sexist attitudes, influence pain care. These findings may inform efforts to raise awareness of sex/gender differences in pain care and reduce disparities.

Keywords: Pain treatment; decision making; sex differences; sexist attitudes; virtual technology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Attitude of Health Personnel*
  • Female
  • Humans
  • Low Back Pain / therapy
  • Male
  • Narration
  • Pain Management / methods*
  • Practice Patterns, Physicians'
  • Psychological Tests
  • Referral and Consultation
  • Sexism*
  • Social Support
  • Surveys and Questionnaires


  • Analgesics, Opioid
  • Antidepressive Agents