UK Study Reveals Women Are Getting Substandard Care for Back and Neck Pain

Women Are Being Let Down by NHS Pain Management Guidelines

Women across the UK are receiving inadequate treatment for chronic back and neck pain, largely because the clinical guidelines shaping their care were designed without accounting for fundamental sex-based biological differences. That is the troubling conclusion of new research emerging from the University of Lancashire.

The study, published in the journal Physical Therapy Reviews, reveals that NHS guidance for the non-surgical management of chronic neck and back pain consistently uses gender-neutral language — referring only to "patients," "individuals," or "people" — effectively defaulting to a male-centric model of care. This approach systematically overlooks the distinct physiological factors that influence how women experience musculoskeletal pain.

The Scale of the Problem

Back pain is far from a minor issue. According to the World Health Organization, lower back pain affects more than 600 million people globally. In the UK alone, the condition costs the NHS billions of pounds each year, contributes to millions of GP consultations annually, and remains one of the primary drivers of workplace absenteeism. Given this enormous burden, the quality and precision of treatment guidelines carry significant consequences.

What the Guidelines Are Missing

The University of Lancashire review found that current clinical guidance completely disregards the influence of several female-specific biological factors, including:

• Skeletal structure — Women generally have a smaller, differently shaped skeleton that responds differently to physical strain
• Hormonal fluctuations — Hormones can directly affect pain sensitivity and musculoskeletal function
• Pregnancy and postpartum recovery — Carrying a child places enormous biomechanical pressure on the spine, and alignment may take months to normalise after birth
• Menopause — Hormonal shifts during this life stage can significantly impact bone density and joint health

Lead author Lauren Haworth, a research associate at the University of Lancashire, highlighted one particularly overlooked example. "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. Yet existing guidance makes no mention of such considerations.

The guidelines also fail to account for the biological characteristics of intersex patients, representing another gap in truly inclusive care.

Pregnancy Places Unique Demands on the Spine

Dr. Anastasia Topalidou, co-author of the study and associate professor in perinatal biomechanics and health technologies, emphasised the profound physical impact of pregnancy on spinal health. "Pregnancy places major biomechanical demands on the spine as the body adapts to the growing foetus," she noted.

Even following delivery, the spine and pelvis can require months to gradually return toward their pre-pregnancy alignment — a reality that has direct implications for how postnatal back pain should be assessed and managed.

Real-World Consequences for Women

The practical impact of these shortcomings is significant. Matthew Parker, associate professor of neuroscience and translational psychiatry at the University of Surrey, warned of a "real risk" that female-specific factors are not being consistently factored into routine clinical assessments.

"That does not mean women are always being misdiagnosed," he clarified, "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."

For many women, this translates into prolonged suffering, repeated healthcare visits, and a diminished quality of life — all of which might be avoided with more tailored, sex-aware clinical protocols.

Calls for Reform

The research is calling on the UK government's women's health strategy to take decisive action by ensuring that sex-specific biological factors are transparently and consistently integrated into the development of future clinical guidelines.

Haworth stressed that acknowledging these differences is not about treating women as a special case, but about delivering genuinely personalised and equitable healthcare. "Women may still be disadvantaged simply because their biological needs differ from those of men," she said.

In response, a spokesperson for the National Institute of Health and Care Excellence (NICE) stated: "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."

A Step Toward More Equitable Healthcare

This study adds growing momentum to the broader push for sex-disaggregated research and gender-sensitive medical guidelines. For the millions of women living with chronic back and neck pain, the message is clear: the current one-size-fits-all approach is not working, and meaningful reform is long overdue.