Sex differences in presentation, course, and management of low back pain in primary care

Clin J Pain. 2008 Sep;24(7):578-84. doi: 10.1097/AJP.0b013e31816ed948.


Objective: Epidemiologic surveys frequently show that women more often and are more affected by low back pain (LBP). The aim of this secondary analysis of a randomized controlled study was to explore whether presentation and course of LBP of women is different from men, and if sex affects the use of healthcare services for LBP.

Methods: Data from 1342 [778 (58%) women] patients presenting with LBP in 116 general practices were collected. Patients completed standardized questionnaires before and after consultation and were contacted by phone 4 weeks, 6 months, and 12 months later for standardized interviews by study nurses. Functional capacity was assessed with Hannover Functional Ability Questionnaire (HFAQ). Logistic regression models-adjusting for sociodemographic and disease-related data-were conducted to investigate the effect of sex for the use of healthcare services.

Results: Women had on average a lower functional capacity at baseline and after 12 months. They were more likely to have recurrent or chronic LBP and to have a positive depression score. Being female was associated with a low functional capacity after 12 months (odds ratio: 1.7, 95% confidence interval: 1.2-2.3), but baseline functional capacity, chronicity, and depression were stronger predictors. In univariate analysis, women had a tendency of higher use of healthcare services. Those differences disappeared after adjustment.

Discussion: Our findings confirm that women are more severely affected by LBP and have a worse prognosis. Utilization of healthcare services cannot be fully explained by female sex, but rather by a higher impairment by back pain and pain in other parts of the body characteristic of the female population.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • Germany / epidemiology
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / epidemiology*
  • Low Back Pain / prevention & control*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods*
  • Prevalence
  • Primary Prevention / statistics & numerical data
  • Risk Assessment / methods*
  • Risk Factors
  • Sex Distribution
  • Treatment Outcome