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


CONCLUSIONS
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.
Chenot
Jean-François
JF
Department of General Practice parallelDepartment of Anesthesiology, Pain Clinic, University Goettingen, Germany. jchenot@gwdg.de
Becker
Annette
A
Leonhardt
Corinna
C
Keller
Stefan
S
Donner-Banzhoff
Norbert
N
Hildebrandt
Jan
J
Basler
Heinz-Dieter
HD
Baum
Erika
E
Kochen
Michael M
MM
Pfingsten
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015995:Prevalence; D011322:Primary Prevention / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome