Women are being ‘shortchanged’ when it comes to treatment for chronic neck and back pain because their specific needs are ‘overlooked’ in clinical practice guidelines, a UK review has concluded.
These guidelines do not explicitly incorporate sex-specific biological considerations, which means biological differences in how the conditions are experienced are overlooked, the team from the University of Lancashire found.
Their review of guidance documents on the non-surgical management of chronic neck and back pain found that female-specific factors such as hormonal fluctuations, skeletal morphology, pregnancy and menopause were not accounted for.
This is despite women experiencing chronic neck and back pain more frequently than men, they wrote in the journal Physical Therapy Reviews.
A ‘male by default’ model of care
Nine guidelines were included in the review, including best practice recommendations from NICE for conditions such as axial spondyloarthritis and ankylosing spondylitis. None of these used the word female, and there were eight mentions of ‘women’ or ‘woman’ across just four of the guidelines, the researchers reported.
They concluded that in the absence of sex-specific differences in the guidance, it falls to individual clinicians to identify and account for them.
While the language used may seem neutral with terms such as ‘individuals’ or ‘patients’, it effectively creates a ‘male by default’ model of care, they argued.
The ‘significant oversight’ could lead to suboptimal care for both male and female patients despite chronic pain being so common, the researchers added.
Informing clinical decision-making
Lead author Dr Lauren Haworth, a senior research assistant in the School of Health, Social Work and Sport, said: ‘Clinical guidelines play an important role in shaping everyday clinical decision-making.
‘Our review found that while guidelines emphasise person-centred care, sex-specific biological considerations are not explicitly incorporated into assessment or management recommendations.’
She added that their findings ‘do not suggest that clinicians are ignoring women’s needs’, but that the paper highlights a lack of visibility for sex-related factors within the formal guidance that shapes care pathways.
Dr Haworth said: ‘If we are serious about individualised, person-centred care, we cannot treat sex-specific biology as an optional extra.
‘Guidelines shape clinical decisions, and if sex-specific biological factors that we know influence musculoskeletal pain are absent at that level, there is a risk they may also be overlooked in practice.’
Co-author Dr Anastasia Topalidou, associate professor in perinatal biomechanics and health technologies at the University of Lancashire, added: ‘Equitable care is not the same as sex-neutral care. When a condition disproportionately affects women, and we know that hormonal fluctuations, skeletal morphology, pregnancy and menopause influence musculoskeletal pain, those differences should be clearly reflected in the guidance that informs clinical decision-making.’
She added: ‘When sex-related factors are not systematically embedded in care frameworks, the risk is not only theoretical, it plays out in persistent pain, repeat consultations, prolonged treatment pathways and reduced work participation.’
Ahead of the Government’s Women’s Health Strategy, Dr Haworth said that the research ‘presents a timely opportunity to ensure that sex-specific biological factors are transparently considered in the development of clinical guidelines. Strengthening that foundation would support more consistent and equitable musculoskeletal care.’
A version of this article was originally published by our sister publication Pulse.