A patient came to my clinic after three years of being told her pain was “probably stress.” She had seen her primary care doctor, two orthopedists, and a neurologist. She had tried medications, been handed pamphlets, and learned to apologize for bringing it up at all. By the time she reached me, she had stopped believing anyone in medicine would take her pain seriously.
She is not unusual. She is the norm. And if you practice medicine anywhere near pain, she is in your waiting room too.
Women’s pain is systematically undertreated and underbelieved in American medicine. Women wait longer for pain medication in emergency departments. Their pain is more likely to be attributed to anxiety or emotions. They are referred later, sometimes years later, for the evaluations that would find the actual source. None of this requires bad intent. It is what happens when a busy system defaults to reassurance instead of a workup.
Here is the part I most want my colleagues to hear: For much of this pain, we already have better answers. The problem is not a lack of tools. It is how rarely women are offered them.
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Interventional pain medicine (targeted nerve blocks, neuromodulation, image-guided procedures) can relieve pain that pills cannot touch. A woman with endometriosis-related pelvic pain who has cycled through hormonal therapies may respond to a superior hypogastric plexus block that interrupts pain signaling at its source. A patient with chronic post-mastectomy pain may find relief from a targeted peripheral nerve intervention instead of another adjustment to systemic medication. These are established procedures, performed every day. Too few women ever hear about them.
Multimodal care matters just as much: non-opioid medications chosen for the specific pain mechanism, physical therapy, behavioral approaches, and, above all, a careful diagnosis of the actual pain generator. The evidence base across pelvic pain, endometriosis-related pain, fibromyalgia, chronic post-surgical pain, and painful bladder syndrome has grown enormously. It just has not reached enough exam rooms.
That gap is why I edited a book on the subject. I wanted the playbook in one place: how women’s pain presents differently, how to work it up, and which interventions actually help, written for the clinicians who see these patients first, not only for pain specialists. If it shortens even one woman’s three-year wait for an answer, it did its job.
So what can you do on Monday morning? Four things.
First, start from belief. When a woman tells you she is in pain, the most therapeutic thing you can do in the first sixty seconds is take her at her word. The data on this is unambiguous; the practice still lags.
Second, work up the pain generator before reassuring. A careful history and exam aimed at the source of the pain (pelvic, neuropathic, musculoskeletal, visceral) changes the treatment plan more often than we admit.
Third, refer early for interventional evaluation. You do not need to master these procedures; you need to know they exist and where to send patients. A pain medicine referral is not a failure of primary care. It is the same logic as a cardiology referral for chest pain.
Fourth, give every plan a destination. A follow-up, a referral placed, a therapy started, a procedure scheduled. “Let’s see how it goes” is where three-year delays begin.
I know the pressures you are under: fifteen-minute visits, full panels, documentation that never ends. Nothing in this essay requires more hours in your day. It asks only that we aim the hours we have at the source of the pain, with the tools modern pain medicine already gives us.
My patient got her answer: a diagnosis, a targeted procedure, and a plan she helped choose. What she said afterward has stayed with me: “You’re the first doctor who believed me.”
Belief is not the whole treatment. But it is where treatment starts.
Anita Gupta is an anesthesiologist.
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research, and scientific society with more than 60,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit ASA online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. ASA publishes Anesthesiology, Anesthesiology Open, and ASA Monitor, and stays connected with members and the public on Facebook, X, Instagram, Bluesky, and LinkedIn.
