Q&A: The Painful Truth About Men's Health

The life expectancy for men in the US is nearly 6 years shorter than women.¹ Why? Too often, it's a combination of dismissing symptoms, skipping yearly checkups and preventative screenings, and avoiding doctors visits—especially when tell-tale signs of pain are present.

Man experiencing back pain / SHOTPRIME STUDIO - stock.adobe.com

And while these behaviors contribute to the problem, they're also consequences of a deeper issue. According to Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, the stigma surrounding men's health has been around for "just about ever." Phrases like "man up" or "tough it out" reinforce the harmful belief that men should endure pain in silence, discouraging them from seeking necessary medical attention.

In a recent conversation with Drug Topics on Over the Counter, Garofoli, host of the Pain Pod and alternatively known as the Pain Guy, discusses the roots of this societal stigma, potential solutions, and his personal experiences with pain.

READ MORE: Q&A: Pharmacists Can Play a Key Role in Supporting Men’s Health

Drug Topics: Hello, my name is Lauren Massaro, and I'm an associate editor with Drug Topics. Today, I’m joined by Mark Garofoli, professor at WVU School of Pharmacy and host of the Pain Pod, and also known as the Pain Guy.

In this episode of Over the Counter, we’ll be chatting about pain in men and dissecting phrases I’m sure many of us have heard, such as “man up,” “tough it out,” or “don’t be such a baby,” as well as discussing how this societal stigma has contributed to a landscape where men feel discouraged from seeking care. Welcome Mark and thanks so much for being here!

Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS: Thank you, as well, Lauren, it’s always a pleasure. I haven’t met a podcast I didn’t enjoy talking on.

Drug Topics: To start our conversation, I wanted to delve into how the societal stigma around men first emerged. So, how prevalent is the societal expectation for men to suppress pain? And what are the cultural and historical roots of this mentality?

Garofoli: Well, I think it's something that could pretty much be anywhere and everywhere. You know, not being an epidemiologist or researching this very intently, I don't think I can whip out any specific numbers or anything, but it's just 1 of those things that's out there. There's a lot of societal perceived norms that certainly come into play. And by the way, a lot of things transcend to everyone, really, whether—you mentioned some terms like “man up,” or anything similar to that along the way—but I mean, this could be male, female, anybody. Just in general, there's the other 1 of, “Hey, suck it up.” I'm not a fan of any of this, by the way, of course, but you know, we hear it. Depending on how far it gets drummed into our brains, [it] will dictate how we proceed and how we roll with that going forward, of course. But, to not recognize [it] is a whole other can of beans overall.

It’s probably been around for a while—just about ever. I don't think we need to go back to the caveman-cavewoman days, but I'm sure there was something out there with some grunts here and there. Again, not in a textbook-like sense, but conversationally speaking. We're human. We've always been human, [so] it’s been around forever, right?

Drug Topics: Can you elaborate on specific instances or personal experiences where you or someone you know has been discouraged from seeking medical attention due to these gendered stereotypes?

Garofoli: As Pain Guy—as often talked about on the Pain Pod on the Pharmacy Podcast Network, of course—we all end up in pain sooner or later. It's part of being human. Unfortunately, another point of view would be, “Hey, pain’s there to remind us that something's a little bit off, so we need to address it.” And that's where I'd really go with the conversation of saying, “Okay, well, when pain is happening, we got to check ourselves.” That's literally the body saying, typically in a very loud and undesired way, that something's up. Let's take a moment of pause, as most people say these days, to address it and figure out what's going on.

Like anyone listening, I've been in pain before. And certainly, pain can be defined [as] psychological, physical, but typically, we're talking on the physical side, and we've all been there. Hopefully more paper cuts than broken femurs, but it's going to happen. Probably 1 of my more profound instances was with a kidney stone right at the beginning of the COVID pandemic, actually. That was an adventure. And, you know, incredible pain—I’m not going to go on the 10-point scale—but there [was] still that innate wonder of, “Do I really need to address this? Let's just get on with our day here.” And our body is literally screaming, “Yeah, actually, yeah, you do need to address it. Come on man.”

Drug Topics: Right, that hope that it'll eventually go away, or deny the pain which sometimes just makes it worse. So, I know we touched on this, but how do phrases like “man up,” “tough it out,” and “don't be such a baby” contribute to the normalization of toxic masculinity and hinder men's health outcomes?

Garofoli: Well, pretty simplistically, I guess I could say [that] with that mentality, that's only going to reinforce the idea of, "I probably don't need to listen to my body. I'll just kind of ride this 1 out here." And it somehow has become just an innate—and I can't say everyone, but the vast majority of all of us. Again, not even just men. I mean, everyone. We all lead busy lives, too. We don't want to be interrupted; we don’t want to be inconvenienced.

You know, I mentioned the kidney stone experience, and I'm sure, unfortunately, a lot of listeners have had that in their past as well too. How that was going down—originally, it was a Friday night in the Garofoli household and that's when we make pizza, and I was making pizza. And by golly, “I'm going to make that pizza,” was the mentality until I couldn't really stand up anymore. And then intelligence eventually sets in, hopefully, but along the way, there is that moment of, "No, I'm doing something, I would enjoy some family time,” and we have to be able to extrapolate that elsewhere to everyone else's lives as well to say, “No, it's pain.” That's the body saying, “Hey, I matter. Listen up.”

Drug Topics: So, you said you couldn't stand up? Did you end up seeking medical attention for that? I mean, you said it was [during] the COVID pandemic, so was [visiting a hospital] too much during the COVID pandemic? Did you take it off your plate [because] there were bigger things to worry about?

Garofoli: No, I listened to my body, and also have to give some credit to my wife to have the [conversation of], not necessarily her saying the exact words of “Hey, your body's telling you something,” but [that] obviously something was up and it's time to think a little bit further. At that point, that particular type of pain—[my wife and I are] in pharmacy, we're not diagnosticians—but we know how to do things. Medication experts, but it goes beyond that. I pretty much knew [by] the point [of pain] and the type of symptoms that [I] either have a gall stone, or something rupturing, or perhaps even a kidney stone, and none of those sound fun. So, odds are we [were] going to be going to the ER [that night].

It was actually the very beginning [of the COVID-19 pandemic]. It was also Friday the 13th—not too lucky of a night for me or anyone really—but [I realized] that all the symptoms pointed to different things that all required attention, so it was time to go get attention. So, my family just dropped me off at the ER because of course, nobody else was allowed into the building, [and] I navigated my way in there. They were doing some construction. So, you know, it was even easier when the question came up of, “Would you like a mask?" And, well, good golly, even by the dust of the construction.

But anyways, I'll never ever forget—I've used this conversation in so many different presentations, even across the country, and I'm pretty sure a Pain Pod episode too—when getting the intake, vitals, whatnot, then of course being asked the question, “How would you rate your pain?” And, you know, I’m trying to be nice, not even professional, but just compassionate to the person asking it because you ask a silly question, you're probably going to get a silly answer most of the time. And I'm like, “Dear golly, Pain Guy in pain, now I'm the 1 being asked this ludicrous question.” And in my head—again, not actually saying this, trying to be nice to those that were providing care to folks—I'm thinking, “Okay, it's the beginning of a pandemic. It's Friday the 13th. I just got dropped off at the ER. What do you think my answer is? 0.25?”

So, I said “8.5,” with the clear intent of having someone stop and start thinking, which is exactly what happened. And then the idea was, oh, well, I want to give a half a point to broken femurs, bear maulings and childbirth, you got to respect all of those things. [But] at least we got that pause to realize, “Okay, remember what you're asking." Like, what does a 7 mean? What does a 10 mean? What does a 1 mean? You're in the ER. And by the way, of course, our ER professionals deal with a lot of things. There might actually be a 1 in somebody in there, it's the world, right? But that was the beginning of that experience. It actually ended up being a 3-month long adventure, I'll say.

But, along the way, there were many opportunities over that 3 months, which should have been 3 weeks—and even 3 weeks is pretty long to deal with pain—but you know, there were many instances of, “Okay, you have to check yourself." Yes, you want to go on, whether you have to for a job or a family, or if you want to because you don't want the inconvenience. It's really the checking oneself because the body is saying something's up.

Drug Topics: Absolutely. So, you sought out medical attention for that. But what are the long-term consequences of men avoiding medical attention due to these societal pressures, or the brushing it under the rug, or the prioritizing—like you said—[the] “I have to be at my job,” [or the] “I have to do my day to day tasks?”

Garofoli: Well, not to hone in on word selection there, but you mentioned the long-term consequences. Well, sometimes if it's major, acute, there might not be a long term. And we see this also not just in acute settings, whether it's broken bones, kidney stones, whatever. We see this in the chronic sense too along the way of, say, getting screenings for cancer, of, “Oh, I'll just put that off another year or so.” And everyone is literally trained—we have the knowledge—that the earlier you find something, clearly the better [outcome]. You're talking life or death really. Yet, we look at our calendar, and it's full, and you have responsibilities, job, family, everything, and there's that postponement thing.

So, you know, it's not just in those little settings within the pain management realm. One of the things I usually like to talk to fellow health care professionals, and in some indirect way patients as well who have centralized pain, [is] that there's pain that—this isn't catastrophizing, or [sensationalizing] here or anything—but it's a reality that pain can become centralized, meaning, [it can spread] all throughout the body if it's not addressed. Because the neurons just get over fired, and then they're all annoyed, and they fight back and say, “Fine, you're not going to address that pain. I'll show you.” Obviously, these are my words, not a textbook, but that's 1 of the really big reasons of addressing something like pain, and not just brushing it off along the way, because it can get worse, not even going to those extreme levels. Like I said, there might not be a long term, not that extreme, but even along the way of just enjoying the ride of life a little bit more.

Drug Topics: Absolutely. Do you think that there's not enough conversation that exists around pain and men? Do you think that men are scared to talk to other men about it as well, in your own experiences?

Garofoli: Based on my own experience, on Third Rock from the Sun, I probably wouldn't say scared. It's more of just a—like a persona. [When] humans get together, we naturally get louder. I've noticed that it's everybody. It's like, “Oh, we have to talk louder.” And then all of a sudden, we have conversations [about] things you might not think the same way [about] or even say, if you were talking individually, just 1-on-1 with someone. It's just natural, it happens. But the idea of not approaching it—there's enough other things to occupy our mouths and our brain space. So, whether it's sports, or whether it's the stock market, or whatever, that's just cooler to talk about. If someone walks into a room and says, “Hey, I want to talk about my kidney stones,” while they’re in pain, then [others] are probably like, “You're probably Mark.” But it's because nobody else is going to do that. Let’s be real.

But it's just not a hot topic. Think of it in a completely different way. My wife and I, Dr. Gretchen Garofoli, we have 2 young boys. And at a certain age, before they're talking, when you're talking with them, or reading a book, you can literally say anything. I mean, they don't know the language. When we say anything, it's how you say it, and what their interest is. That’s different once people know our language, and then all of a sudden, what you say matters, of course. It's almost like we should pull on an essence of that of like, okay, what would you tell an infant or a young toddler? Bring that up in conversation with the old guys and gals, too.

So, it's just not the cool topics. And that's something that really takes that, how do you get people's attention? I may be digressing here, but it's like social media. Is it pictures or whatever, but how do you truly get someone's attention? And in conversation that's even harder than things like social media and scrolling and even manuscripts being published. People’s time is very valuable and getting that attention [is hard]. There's awareness months, there's awareness days, and they have positive impact, but they're not going to change every conversation that folks are having at a tailgate every weekend in the fall. And that's really where the special sauce is.

Drug Topics: Definitely. Yeah, that attention piece is so important because it's so valuable. So, what are some effective strategies for challenging these harmful stereotypes and encouraging men to prioritize their health?

Garofoli: Bring it up. Right off the bat, I mean, we're honing in on men here. Maybe we have our groups of friends, whether it's from pharmacy school, college, work, fantasy football, or whatever league along the way, it takes that 1 little catalyst to just get the conversation going. And I'm checking myself here, too. I'm like, “Man, should I be making a text message to my buddies after this conversation?” The answer is probably yes. Unless I want to be a hypocrite. Right? So hey, friends, if you're listening, that's where that text message came from in the future.

But anyway, just the idea of bringing it up along the way. That's probably the easiest, the most streamlined, yet kind of hard [way], because who wants to bring it [up]? You always need that 1 person to bring it up. In this case, you want to be that guy to talk about November; that's Men's Health Awareness Month. I think a year or 2 ago, I grew a beard. It was contrary to the intro in my podcast [that introduces] the mountain man without the beard, and I'm like, "Man, for a month or 2, I grew a beard, go figure." It's like I was lying in the podcast, right? No, just the intro. But that's something that catches someone off guard, like, “Why haven't you shaved?” You're doing presentations at conferences and stuff, and it's like, “Oh, glad you asked.” And then there's a conversation.

[But] we don't need that level all the time. Stories: storytelling is really where it's at for any type of education. You know, we have [DiPiro’s Pharmacotherapy], the textbook for all medicines, thousands of them, but boy, if it was a storybook, everybody would be a PharmD. It would actually be much easier. But we all have our stories. I walked through the first couple minutes of my kidney stone story, I hope to never have another 1, of course, we don't want kidney stone 2.0. But anyways, the stories when people have things, whether it's sharing what their parents went through, [what] their neighbor went through, anything like that, they stick with us a lot more. It's really all about stories along the way, not just facts.

For instance, when I'm talking about the opioid crisis, the overdose crisis, I could say “There's 109,000 Americans that died last year of a drug overdose,” and [while] that's staggering, 4 seconds later you've probably forgotten it. Or I could say, “Hey, an American dies every 6 minutes [of an overdose]." So that's, what, 3 or 4 already statistically, in this conversation alone? You might still forget that, but it'll stick around in the brain a little bit longer, hopefully, minutes or hours, not just a couple minutes.

Drug Topics: Yeah, definitely. And also hearing that seeking medical attention works, I think is helpful for people who maybe are hesitant or skeptical.

Garofoli: Just bring it up. It's half the conversation. Don’t worry about being that guy. If you have a group of 10 people and they're your friends and you bring something up, and they're like, “Yeah, that was weird,” but 1 of them then goes and gets care that they wouldn't have gotten, well go home and feel good.

Drug Topics: Thanks so much for chatting with me today.

Garofoli: Thank you as well. You have a great rest of your week too, Lauren.

Drug Topics: Bye, have a great day.

READ MORE: Pain Management Resource Center

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References

1. Improving men’s health. News Release. USA Gov. May 23, 2024. Accessed August 7, 2024. https://www.usa.gov/features/improving-mens-health