Chronic pain affects millions in the UK, placing a significant burden on the National Health Service. But a new study reveals a potentially critical flaw in how that pain is addressed: clinical guidelines often fail to account for the biological differences between men and women, potentially leading to inadequate care for female patients. Researchers at the University of Lancashire found that a “male by default” approach to musculoskeletal pain management overlooks factors specific to women, impacting diagnosis and treatment.
The research, published in the Physical Therapy Reviews journal, highlights how commonly used guidelines often refer to “people,” “individuals,” or “patients” without acknowledging how skeletal size, hormonal fluctuations, pregnancy, or menopause can influence experiences of back and neck pain. This oversight extends to intersex patients as well, whose unique biological characteristics are similarly ignored. The findings raise concerns about equitable healthcare access and the potential for prolonged suffering for women experiencing chronic pain.
Lower back pain is a global health issue, affecting over 600 million people worldwide, according to the World Health Organization. In the UK, back pain is a major driver of healthcare costs, costing the NHS billions of pounds annually and accounting for millions of general practitioner (GP) appointments each year. Musculoskeletal disorders also remain a leading cause of operate absence.
Biological Differences and Pain Perception
Lauren Haworth, research associate at the University of Lancashire and lead author of the study, emphasized the importance of considering sex-specific biology for personalized and 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 explained. However, due to the fact that existing guidance doesn’t acknowledge these sex-based differences, “women may still be disadvantaged simply because their biological needs differ from those of men.”
The impact of pregnancy on spinal health is also a key consideration. Dr. Anastasia Topalidou, co-author of the study and associate professor in perinatal biomechanics and health technologies, noted that “Pregnancy places major biomechanical demands on the spine as the body adapts to the growing foetus.” She added that even after childbirth, it can take months for the spine and pelvis to return toward their pre-pregnancy alignment, potentially contributing to ongoing pain.
Calls for Change in Women’s Health Strategy
The study’s authors are calling for the government’s women’s health strategy to explicitly address the need to consider sex-specific biological factors in the development of clinical guidelines. This would ensure that healthcare professionals are equipped to provide more tailored and effective care for female patients experiencing musculoskeletal pain.
Matthew Parker, associate professor of neuroscience and translational psychiatry at the University of Surrey, warned of the potential consequences of overlooking these factors. “There was a real risk that these female-specific factors were not considered consistently in routine care,” he said. “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.”
A spokesperson for the National Institute of Health and Care Excellence (NICE) stated that their 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.”
This research underscores a growing awareness of the need for sex-specific medicine – recognizing that biological differences between men and women can significantly impact health outcomes. As the NHS continues to grapple with the challenges of chronic pain management, incorporating these findings into clinical practice could be a crucial step towards providing more equitable and effective care for all patients.
The implications of this study extend beyond back and neck pain, potentially influencing how other conditions are assessed and treated in women. Further research is needed to fully understand the extent of this “male by default” bias in healthcare and to develop strategies for mitigating its impact. What remains clear is the need for a more nuanced and personalized approach to pain management that acknowledges the unique biological realities of both men and women.
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Disclaimer: This article provides informational content and should not be considered medical advice. Please consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
