Research connects higher incidences of musculoskeletal pain in females, plus increased pain severity

This article shares research connecting higher incidences of musculoskeletal pain and increased pain severity in females. It also explores treatment differences and how chiropractic can help. 

Results from the National Health Interview Survey (NHIS) suggest one in two adult Americans have a musculoskeletal condition. While many factors can contribute, a review of recent studies found the risk of musculoskeletal pain in females is disproportionate and can come with greater pain severity.  

Sex differences: Musculoskeletal pain in females

A review published in the International Journal of Environmental Research and Public Health in March 2023 analyzed the prevalence of the top four musculoskeletal conditions within the U.S.: chronic low–back pain, chronic neck pain, osteoarthritis and rheumatoid arthritis. Each of these conditions was found to affect a higher percentage of biological females than biological males. Musculoskeletal pain in females was also often more severe.  

The authors theorized why females might be at greater risk of these types of musculoskeletal issues, as well as why they might experience more severe pain:  

• Neck pain. Females may have an elevated risk of pain in the neck due to structural factors (i.e., smaller cervical vertebrae and reduced muscle strength), with levels of pain experienced being affected by differences in pain sensitization processing and females having an elevated risk for psychological distress.  
• Low–back pain. Differences in the prevalence and severity of low–back pain in females are also likely both biological and psychosocial. One potential factor is females having a higher risk of depression, which often co-occurs with chronic pain. Other contributing causes include pregnancy, child-rearing and lumbar disc degeneration related to menopause. 
• Osteoarthritis. The risk of this musculoskeletal condition is greater for post-menopausal females, with older females also having more severe knee osteoarthritis. Increased pain and inflammation in females have been associated with lower endogenous estradiol, progesterone and testosterone levels. Additionally, females tend to have more pro-inflammatory cytokines, whereas males typically have a higher amount of anti-inflammatory chemokines. 
• Rheumatoid arthritis. Females, in general, are more often afflicted with autoimmune disorders, also tending to have poorer treatment outcomes. Research suggests genetics, hormones and immune system differences as likely contributors. Females have lower muscle strength and bone density than males, which may play a role as well. 

In addition to musculoskeletal pain, a 2021 perspective review adds evidential support for other pain-based conditions appearing more often in females. They include migraines, fibromyalgia and potentially bladder pain syndrome, though the prevalence of the latter by sex remains uncertain due to research interpretation and variability issues.  

Musculoskeletal pain in females: Treatment differences

Just as there are differences in the prevalence and severity of musculoskeletal pain in females, there are also differences in their response to treatment. Research published in the Journal of Bone and Joint Surgery explores their response to opioids. 

This review indicates prescription opioid misuse is reported more often in women than in men, with misuse even being higher in females as young as the seventh grade. Some women use these drugs to self-medicate for physical or mental health conditions. Plus, opioid misuse is common with depression and post-traumatic stress disorder, two conditions that can result from partner violence, which disproportionately affects women. 

Chiropractic can help females with musculoskeletal pain and other conditions

Research supports chiropractic for reducing opioid use, and also reducing pain severity. This makes chiropractic an effective treatment option that can help female patients reduce their reliance on opioid medications while resolving the underlying issue in the process. 

Talk to female patients about differences in pain prevalence and treatment effects so they understand why they may not have the same experience as their male counterparts. Also, explain how chiropractic can help, in terms of reducing both pain incidence and severity. 

Final thoughts

Pain may appear more often in females and be more severe, women have many viable treatment options. Help your female patients see chiropractic’s ability to successfully reduce their musculoskeletal pain, despite a biological predisposition for these issues.