“Why are we learning this?” is a common question asked by healthcare students when introduced to evidence-based practice (EBP). Yet, when we take a closer look at the unequal treatment of pain across sexes in modern healthcare, the answer becomes startlingly clear. Research continues to demonstrate that men and women experience, express, and respond to pain in fundamentally different ways due to a combination of biological, psychological, and sociocultural factors. Despite this, many clinical approaches remain rooted in outdated assumptions, often leading to the undertreatment of women’s pain and misattribution of their symptoms. EBP provides a vital framework to challenge these disparities through critical appraisal and the integration of high-quality, current evidence.

This paper explores sex-based neurological differences in pain perception, examines the gender gap in pain treatment, and critically analyses the application of the biopsychosocial model. In doing so, it offers student nursing associates a lens to apply EBP not only in assignments but in transformative, person-centred care.

Why Evidence-Based Practice Matters

EBP integrates the best available research with clinical expertise and patient values (Sackett et al., 1996). For students, it fosters critical thinking, ethical decision-making, and the capacity to challenge assumptions. EBP equips future nurses to ask: Why is this the standard? Does it apply equally to all? Is there better evidence?

Teaching students to evaluate research also encourages accountability. For instance, understanding that many historic pain studies excluded women highlights the need for scrutiny over generalised findings. Today’s nursing associate must not only administer care but advocate for equitable practice grounded in current evidence.

Understanding Sex Differences in Pain: A Biopsychosocial Framework

Biological sex influences every level of pain processing. Neuroimaging has shown that women exhibit greater activation in brain areas like the insula and thalamus in response to the same pain stimulus compared to men (Paulson et al., 1998). Sex hormones, especially oestrogen, modulate pain signalling and may account for fluctuations in pain sensitivity across the menstrual cycle (Paredes et al., 2019).

Women are also more likely to develop chronic pain conditions, including fibromyalgia, endometriosis, and osteoarthritis. Despite this, they are often less likely to receive adequate pain relief (King’s College London, 2023). In fact, research consistently shows that men are more likely to be offered analgesia and opioids in emergency settings.

Psychologically, women are more frequently characterised as catastrophising their pain. This term, increasingly criticised as stigmatising and imprecise, is associated with helplessness, rumination, and amplified pain reporting (Sullivan & Tripp, 2024). Such labels can lead clinicians to dismiss legitimate pain complaints and to underestimate women’s experiences, reinforcing diagnostic bias.

Socially, women face cultural expectations to tolerate pain or present stoically. Racine et al. (2012) concluded that gender norms shape both the expression and clinical response to pain. Additionally, discrimination, whether due to race, gender, or weight, has been shown to elevate psychological distress and, in turn, intensify chronic pain symptoms through neuroendocrine dysregulation.

The biopsychosocial model brings together these three domains,biological, psychological, and social, emphasising that effective pain management must address the whole person, not just the body part affected. This model, endorsed by the International Association for the Study of Pain, recognises that women’s pain is often misunderstood due to intersecting factors that go beyond pathology

How Pain Is Currently Identified, and Why It Must Change

Traditional pain assessment relies heavily on self-report, such as the numeric rating scale (NRS), which asks patients to rate pain from 0 to 10. While this is standardised, it is highly subjective and influenced by cultural norms, gender expectations, and prior experiences.

This model falls short when considering the evidence that women may feel, process, and express pain differently. Female patients often report pain at multiple sites and with higher severity, yet their accounts are discounted or minimised more frequently than men’s (Templeton, 2020).

New knowledge empowers student nurses to approach pain with a more holistic, trauma-informed lens. Rather than assuming exaggeration or poor tolerance, practitioners can ask: What does this pain mean for this individual, in this moment, given their history, context, and identity?

By understanding the biopsychosocial complexity of pain, students can question assumptions, interpret pain expressions more empathetically, and advocate for equitable treatment, an essential application of EBP.

Implications for Practice

For educators and practitioners, the key implications include:

• Moving beyond the pain scale: Incorporate qualitative descriptions, patient narratives, and consider cultural and gendered expressions of distress.
• Embedding the biopsychosocial model: Training must incorporate physical, emotional, and social dimensions of pain—not just diagnosis and drugs.
• Updating clinical guidelines: Encourage inclusion of sex-disaggregated data in research and avoid generalising male-dominant study results.
• Empowering patients: Women need to be believed, supported, and engaged in co-constructing their pain management plans.

Conclusion

Teaching EBP is not just about preparing students to write assignments, it is about preparing them to challenge inequality, recognise bias, and transform care. As we have seen, pain is not experienced equally across sexes, nor is it treated equitably. Nursing associates equipped with EBP principles and biopsychosocial knowledge are vital for disrupting outdated models and providing compassionate, inclusive care

References (Harvard Style)

Brown, T.T., Partanen, J., Chuong, L., Villaverde, V., Griffin, A.C., & Mendelson, A. (2018) ‘Discrimination hurts: The effect of discrimination on the development of chronic pain’, Social Science & Medicine, 204, pp.1–8. https://doi.org/10.1016/j.socscimed.2018.03.015.

International Association for the Study of Pain (IASP). (2022) Global Year: Pain in Women – Real Women, Real Pain. [online] Available at: https://www.iasp-pain.org/advocacy/global-year/pain-in-women/ [Accessed 14 May 2025].

Johnson, S., Bradshaw, A., Bresnahan, R., Evans, E., Herron, K., & Hapangama, D.K. (2025) Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review, BJOG: An International Journal of Obstetrics & Gynaecology, 132, pp.266–277. https://doi.org/10.1111/1471-0528.17987.

King’s College London. (2023) Study finds women less likely to be prescribed pain relief than men. [online] Available at: https://www.kcl.ac.uk/news/study-finds-women-less-likely-to-be-prescribed-pain-relief-than-men [Accessed 14 May 2025].

Racine, M., Tousignant-Laflamme, Y., Kloda, L.A., Dion, D., Dupuis, G., & Choinière, M. (2012) ‘A systematic literature review of 10 years of research on sex/gender and experimental pain perception – Part 1: Are there really differences between women and men?’, Pain, 153(3), pp.619–635.

Sullivan, M.J.L., & Tripp, D.A. (2024) ‘Pain Catastrophizing: Controversies, Misconceptions and Future Directions’, The Journal of Pain, 25(3), pp.575–587. https://doi.org/10.1016/j.jpain.2023.07.004.

Templeton, K.J. (2020) ‘Sex and Gender Issues in Pain Management’, The Journal of Bone and Joint Surgery, 102(Suppl 1), pp.32–35. https://doi.org/10.2106/JBJS.20.00237.