Understanding women in pain: New pathways suggested by Umea researchers: Qualitative research and feminist perspectives

Abstract

A substantial proportion of GPs' patients are women who suffer from 'unexplained' pain conditions, often from the musculoskeletal system. Few medical findings are revealed, although the symptoms lead to extensive suffering and disability. Two experienced Swedish GPs, Katarina Hamberg and Eva E Johansson, took their own frustration as their point of departure to explore the expectations, experiences, family lives and working lives of women who were sick-listed due to chronic musculoskeletal pain. Their doctoral dissertations, defended at the 0University of Umea in September this year, are based on a qualitative interview study with 20 women aged 21-61 years. Johansson and Hamberg found that when seeing a doctor, the women expect to be seen, heard and taken seriously, to get information and time for discussion with the doctor, and to receive help and support over time. However, they experienced being ignored, disregarded and rejected. Symptom perception was characterized by loss of control and feelings of threat and unpredictability. The women believed that the pain had a bodily origin triggered by various mechanisms such as heavy and monotonous work, environmental influences, tensions and worries, rightful punishment or heritage. The Swedish study showed that family considerations had a strong impact on organizations and priorities in paid work. In this sample of working class women, family orientation strengthened and works aspiration declined in a situation of pain and sick leave. Problems related to rehabilitation could be explained by looking more closely on home conditions, especially the unwritten deal among the woman and her partner regarding the division of duties and power structure - the marital contract. Experiences of abuse and violence were reported to Hamberg and Johansson by several women, most of them considering this to be one root of their pain and ill health. The women emphasized that an understanding doctor would ask about violence, apprehend the hints, confirm that it was acceptable to talk about it, and avoid the questioning and blame that easily might increase the woman's feelings of guilt.