Women are receiving worse treatment for back and neck pain because their experiences are not factored into “male by default” clinical guidelines in the UK, research has found.
The NHS fails to acknowledge sex-specific considerations such as pain being more common among women in its model of care for non-surgical management of chronic neck and back pain, according to research from the University of Lancashire.
Lower back pain affects more than 600 million people worldwide, the World Health Organization states. Back pain costs the NHS billions of pounds each year and chronic pain accounts for millions of GP appointments annually, while musculoskeletal disorders remain one of the leading causes of work absence in the UK.
A major review of clinical guidance, published in the Physical Therapy Reviews journal, found that by consistently only referring to people, individuals or patients, clinical guidance in the UK ignores the role women’s different skeleton size, hormones, experience of pregnancy or menopause can play in musculoskeletal pain. Guidelines also ignore the different biological characteristics of intersex patients.
Lauren Haworth, research associate at the University of Lancashire and lead author of the study, said that considering sex-specific biology was important to deliver personalised, equitable healthcare.
“We know that large breasts can be heavy, and without adequate support this additional weight, combined with gravity, can cause strain on a woman’s body, which may contribute towards neck and back pain,” she said.
But she added that because existing guidance doesn’t acknowledge sex-based differences, “women may still be disadvantaged simply because their biological needs differ from those of men”.
Having children can also affect experiences of pain. Dr Anastasia Topalidou, co-author of the study and associate professor in perinatal biomechanics and health technologies, said: “Pregnancy places major biomechanical demands on the spine as the body adapts to the growing foetus.”
Even after birth, the spine and pelvis can take months to return toward their pre-pregnancy alignment, she added.
The study calls for the government’s women’s health strategy to ensure that sex-specific biological factors are transparently considered in the development of clinical guidelines.
Matthew Parker, associate professor of neuroscience and translational psychiatry at the University of Surrey, said there was a “real risk” that these female-specific factors were not considered consistently in routine care.
“That does not mean women are always being misdiagnosed, but it does mean some women may be assessed less precisely, treated less effectively, and end up in longer cycles of persistent pain and repeat appointments,” he said.
A spokesperson for the National Institute of Health and Care Excellence, said: “Our guidelines encourage doctors to tailor care to each person’s individual needs, and we welcome research that helps us improve the guidance we provide. We will consider these findings carefully as part of our ongoing commitment to ensuring our guidance is useful, useable, and works for everyone.”
