Is Back Pain Affecting Women’s Lifespans?

Is Back Pain Affecting Women’s Lifespans?

A 2021 research review in the Journal of General Internal Medicine suggests an elevated mortality risk for women with back pain, but that association wasn’t true for men in the research.

“We don’t have an answer as to why this would be true for women compared to men,” says lead author Eric Roseen, DC, in the Department of Family Medicine at Boston University School of Medicine and Boston Medical Center. “We were surprised by these results, and it shows that we need to take a closer look at this association for women.”

Dr. Roseen and fellow researchers identified 11 cohort studies that showed associations between back pain and all-cause mortality in follow-up periods that ranged from five to 23 years, and represented just over 81,000 participants. 

They found that mild back pain was unlikely to impact longevity for either men or women, but that risk of mortality increased as the severity of pain did. That association was stronger in studies of women, says Dr. Roseen.

Although the research did not dive into causation, he adds that there are some possible reasons for why this might be the case. For example, biology may play an important role here, since women tend to have a higher incidence of osteoporotic fractures, he says, but that’s unlikely to be the only factor driving this association.

Other factors could be undertreatment, overtreatment, reduced physical activity due to pain, and weight gain that puts women at risk for obesity-related conditions. For example, commentary published in Mayo Clinic Proceedings pointed out that weight gain is common in women after menopause, particularly in the abdominal region. 

That central obesity, the commentators note, puts women at high risk of several adverse metabolic consequence, including hypertension, cardiovascular disease, dysglycemia, and dyslipidemia, as well as increased incidence of arthritis, mood disorders, and some cancers.

“Older women are more likely than older men to have debilitating back pain, which may increase risk of other chronic health conditions, and those issues need to be researched,” says Dr. Roseen. “Because we’re seeing such differences between men and women, it’s important to evaluate why that might be the case.”

Related in large part to estrogen deficiency and its effect on accelerated disc degeneration, older women tend to have higher prevalence of low back pain compared to younger women and men of any age. According to a literature review in Quantitative Imaging in Medicine and Surgery, this prevalence keeps increasing as they get older. That study found this issue even affects school-age children, with girls more likely to have back pain than boys, possibly due to hormone fluctuation.

Some issues, like bone density, affect both men and women, but women are subject to some causes that men don’t have to deal with at all. That includes:

Certain conditions men do experience that affect back pain, such as UTI, bladder infection, osteoporosis, and piriformis syndrome, tend to be more prevalent in women as well. Another factor, says Dr. Roseen, is that clinicians may not take women’s pain as seriously as their male patients, particularly when back pain may not be debilitating. That could mean that women wait longer for more effective treatment, he says, and their condition is only truly addressed when it becomes more problematic. 

“Unfortunately, our findings raise a concern that women’s pain may be minimized or undertreated compared to men,” he says. “However, we could not identify any studies that looked at the role of treatment for back pain on mortality. It is possible that women experience more treatment, or more invasive treatment, and that potential side effects of treatment contribute to the increased risk of mortality.”

Given the study’s findings about the association with early mortality risk and back pain in women, it’s important for both clinicians and patients to take the incidence of pain seriously, and to focus on better management even in early stages of pain, Dr. Roseen believes.

That includes some tried-and-true strategies that have been proven to help maintain bone density and muscle mass, as well as overall mobility, including:

“Staying active is probably the most important part of self-care for back pain. Exercise also lowers other health risks as well, such as cardiovascular issues,” says Dr. Roseen. “As people age, especially women, they need to be encouraged to move more, and move often. And if they start to experience back pain, especially back pain that limits physical activity, they should get it assessed before it becomes worse.”

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