UK Clinical Guidelines Fail to Account for Sex-Specific Pain Differences, Research Finds

Women in the United Kingdom may be receiving suboptimal treatment for back and neck pain due to clinical guidelines that operate under a “male by default” framework, according to new research. The National Health Service (NHS) model of care for non-surgical management of chronic neck and back pain currently fails to adequately acknowledge sex-specific considerations, potentially leading to inequitable healthcare outcomes.

Prevalence of Back Pain and its Impact

Lower back pain is a widespread health concern, affecting over 600 million people globally World Health Organization. In the UK, back pain places a significant burden on the NHS, costing billions of pounds annually and accounting for millions of general practitioner (GP) appointments each year. Musculoskeletal disorders are also a leading cause of work absence in the UK.

Study Findings: Ignoring Biological Differences

A recent review published in the Physical Therapy Reviews journal revealed that UK clinical guidance consistently uses gender-neutral language – referring to “people,” “individuals,” or “patients” – which overlooks the impact of biological factors specific to women and intersex individuals. These factors include differences in skeletal size, hormonal influences, the experience of pregnancy, and menopause.

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 stated. The study highlights that the failure to acknowledge these differences may disadvantage women whose biological needs differ from those of men.

The Impact of Pregnancy and Postpartum Recovery

The research also points to the biomechanical demands placed on the spine during pregnancy as a significant factor in back pain. Dr. Anastasia Topalidou, co-author of the study and associate professor in perinatal biomechanics and health technologies, explained that pregnancy causes substantial adaptations in the body to accommodate the growing fetus. The spine and pelvis can take months to return toward their pre-pregnancy alignment even after childbirth.

Call for Change in Women’s Health Strategy

The study urges the government’s women’s health strategy to prioritize the transparent consideration of sex-specific biological factors in the development of clinical guidelines.

Potential Consequences of Ignoring Sex-Specific Factors

Matthew Parker, associate professor of neuroscience and translational psychiatry at the University of Surrey, warned of a “real risk” that these female-specific factors are not consistently considered 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.

NICE Response and Ongoing Commitment

A spokesperson for the National Institute for Health and Care Excellence (NICE) stated that their guidelines encourage doctors to tailor care to each person’s individual needs and that they welcome research to improve their guidance. NICE will carefully consider these findings as part of its ongoing commitment to ensuring its guidance is useful, useable, and works for everyone.