From pain research to daily practice to advocating for policy change, Practical Pain Management speaks to the women pushing pain medicine forward.
We know that women have higher response rates to pain, experience more chronic pain conditions, and face more disparities in research about and care for their pain. Pain in women, along with its bedside partner – mental health – has become so prominent in clinical settings and at-home conversations that HealthyWomen launched a Chronic Pain Advisory Council earlier this year. In just the past few years, PPM's own recent special reports dove into gender bias around women’s pain, gender gaps in pain medicine, and the never-ending search to adequately assess and treat chronic pelvic pain in women. We even launched a new series on overlapping pelvic pain disorders to address growing needs in this often overlooked set of conditions.
We could go on to provide even more statistics and data about how pain is – and is not – treated in women, but instead we are going to pay homage to the women treating pain.
VANILA M. SINGH, MD, MACM
Clinical Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine
Immediate Former Chief Medical Officer, US Department of Health and Human Services (HHS), Office of the Assistant Secretary of Health
Chairperson, Best Practices Pain Management Inter-Agency Task Force, HHS
A lot of your work includes translating pain research into policy efforts and patient advocacy. Why do you feel this is important in general, and how does your role as a woman and a member of the BIPOC community drive your ambition and passion for this work?
Dr. Singh: If there is anything that I have learned in my career at the intersection of medicine and policy, it is that policy can often be well-intentioned but often ineffective. It has always been important to me to see well-intentioned policies executed in an impactful way that really helps people. It is up to us as experts in these fields to ensure that important policies do not get watered down or lost in the scuffle of government.
In addition to my medical background, I have always had an interest in history, politics, and economics. These subjects are critical to understanding how the world works and our country has evolved. That is why I had decided to double major at UC Berkeley where I studied molecular & cell biology and economics. I saw the value and importance of market forces and I learned government policy often determines them.
To have a true impact in medicine you must also understand other stakeholders and in particular our government and how it works to shape policy. My education and career experiences have helped me appreciate the importance of seeing the “big picture” to truly understand market forces and then to alter them. To effect positive change for patients and people it always starts with advocacy through policy and education as well as keeping the pulse of the trenches – this is essential for success in these areas.
As far as being a woman, I can say that the road has been filled with hurdles partly related to the field of (pain) medicine but also due to the innate nature of the evolving roles of women in leadership. I feel strongly about the people I care for. My role as a mother, a daughter, a sister, and an aunt has helped me develop the patience and empathy that helps my work with patients. As a woman in this field, I have undoubtedly experienced discrimination that, at one time, I chose to ignore or deny because I simply wanted to avoid the negative repercussions. Despite these challenges, I chose to forge ahead and not let issues distract me from my goals. I am thankful that things are changing, and we can now speak openly about the very real disparities that continue to exist for women.
Despite your great success in the field, including running the Pain Management Inter-Agency Task Force (see a prior conversation) and serving as CMO at HHS, have you ever felt like you were an outsider at a pain conference or professional meeting, by just being a woman?
Dr. Singh: Absolutely, I have had this feeling on many occasions. It was when I finished my residency over 20 years ago – when women were slowly starting to join and surpass men in the ranks in medicine. You hardly ever saw a female leader or chairperson. Back then, women in medicine had to rely on each other for support and you would be lucky to have that sort of mentorship. As women in the field of medicine, we have a shared experience of sometimes but all too commonly being made to feel like an outsider in our own place of work. On the positive side, experiences like these help women build trust with each other. These relationships are often maintained outside of professional activities as well. We stick together because we trust each other and that has helped bring about change and equality for women in this field.
What has frustrated you most throughout your career? And simultaneously, what do you love most about your work – what motivates you?
Dr. Singh: The most frustrating aspect of medicine is not being able to provide the care that you know your patients need. Sadly, I have felt this frustration a lot over the years – often due to issues with the healthcare system, failing treatments, and limited choices. However, over time I realized that a frustrated state is a wasted state and this energy was better channeled to learning and understanding how these decisions were made and I get involved in the process of healthcare policy instead of dwelling on my frustration. I learned how appropriations for funding and resources were being driven to areas like research and development, academia and industry and I used that knowledge of the system to better advocate for patients.
I believe strongly that an essential part of the profession is advocating for a better situation for our patients to have better outcomes. This to me is really the human element of the profession. And, without a doubt, the most fulfilling part of what I do is an impact positive outcome on people’s lives. That is what has fueled my passion for this industry and why I have dedicated my life to this work.
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