Women ‘overlooked’ in back and neck treatment guidelines, researchers warn

Women are being ‘shortchanged’ when it comes to treatment for neck and back pain because their specific needs are ‘overlooked’ in the guidance, a review has concluded.

UK clinical practice guidelines for chronic neck and back pain do not explicitly incorporate sex-specific biological considerations which means biological differences in how the conditions are experienced are overlooked, a team from the University of Lancashire found.

The review of guidance documents on non-surgical management of chronic neck and back pain found that female-specific factors such hormonal fluctuations, skeletal morphology, pregnancy and menopause were not accounted for.

This is despite women experiencing these conditions more frequently than men, they wrote in the journal Physical Therapy Reviews.

Related Article: Lyme disease: what nurses need to know

Nine guidelines were included in the review, including best practice recommendations from NICE. None of them used the word female, and in four there were eight mentions of ‘women’ or ‘woman’, 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, they added.

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.’

Related Article: Specialist children’s nursing workforce ‘under intense pressure’

She added that their findings ‘do not suggest that clinicians are ignoring women’s needs’, but their paper highlights that sex-related factors are not made visible within the formal guidance.

Dr Haworth said: ‘When something is not explicitly acknowledged in guidance, it risks being inconsistently addressed in practice.

‘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: ‘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.’

Chronic pain is one of the leading causes of work absence and accounts for millions of GP appointments each year, she noted.

Related Article: Over one million switched to combined asthma inhalers since NICE update

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.’

This article was first published by our sister title Pulse