Male and female doctors treat back pain differently – new US findings

Lower back pain treatment decisions may depend on whether the doctor is male or female, according to findings from Touro College in the US. And neither gender follows recommended guidelines for treating this common and costly health problem.
“Male physicians were more likely to refer, and pain relief was more likely to be recommended by female physicians,” explains lead author, Dr Shira Schechter Weiner. “Most recommendations were outside of the guidelines, based on the case that was presented.”
The research team looked at why doctors don’t follow low back pain treatment guidelines and if a physician’s gender influenced the type of treatment they recommended. They surveyed 284 doctors from five leading New York City hospitals, on how they would treat a hypothetical case of acute low back pain.
Male physicians were 10 times more likely than female doctors to say they would refer the patient to an orthopaedist, and 2.5 times as likely to refer to a physiatrist (neither of which are recommended by evidence-based guidelines).
Female doctors were more likely to recommend pain relief, including muscle relaxants and thermal treatments (both against guidelines), and were more likely to recommend manipulation to relieve pain. Women physicians were also more likely to recommend computed tomography scans for the patient, again against guidelines.
“Low back pain is a very large and costly problem,” Dr Weiner says. “We have many guidelines that can help us understand how to manage this common problem, in an effort to optimize the outcome for the patient in the least expensive way possible, and the guidelines are not being followed as they should be.”
Current US guidelines from the American College of Physicians and the American Pain Society for treating acute low back pain include offering information and reassurance, recommending over-the-counter medication, and providing manipulation of the affected part of the back, which can be done by physical therapists or chiropractors. But these guidelines are often not followed.
“We need to all focus on preventing chronicity in these patients, and be committed to providing the best evidence-based care that has been shown to achieve that goal. If we do the wrong thing the patient’s more likely to become chronic, so we have to find ways to help clinicians do the right thing, because it’s been shown to improve outcomes for patients.”

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