The Gender Pain Gap in Prehospital Analgesia: The Role of Patient and Provider Gender – An Analysis of 106,888 Helicopter Emergency Medical Service (HEMS) Missions

Background Pain management is a core ethical principle in emergency medicine, yet gender-related differences in analgesic treatment have been reported. This study examines whether patient and emergency physician gender influence prehospital pain management. Methods This retrospective observational cohort study included all primary helicopter emergency medical service missions conducted by DRF Stiftung Luftrettung in Germany between January 2012 and June 2025. Adult patients (≥ 18 years) with a Glasgow Coma Scale score ≥ 11 and without airway management were analyzed. Pain severity was assessed using the Numeric Rating Scale (NRS). Patient characteristics, analgesic treatment, and emergency physician gender were analyzed using descriptive statistical methods. The study was approved by the Ethics Committee Freiburg (25-1272-S1, August 19th 2025). Results A total of 106,888 cases was included, of which 38.5% were female and 61.5% male. Initial pain severity was comparable between genders, with a similar distribution across NRS categories. Despite this, women received analgesic treatment less frequently than men (62.0% vs. 66.9%; p < 0.001), whereas a greater effect is seen when particularly examining the use of opioid analgesics (50.0% vs. 57.1%; p < 0.001). This finding is consistent across all pain severity subgroups. Pain scores at patient handover were similar for women and men, indicating comparable pain levels at the end of prehospital care. Conclusion Despite comparable pain intensity, women received analgesic and opioid treatment less frequently than men in prehospital care, indicating potential gender-based inequalities in pain management. These findings underscore the need for strategies to ensure equitable analgesic treatment.