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January 14, 2026BMJ Open0 citationsOpen Access

International perspective on healthcare provider gender bias in musculoskeletal pain management: a scoping review

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KWKatherine F. WilfordMMMaria Jesus Mena-IturriagaMVMargaret Vugrin

Key Points

  • This review aims to map the literature related to healthcare provider gender bias in musculoskeletal pain management and identify research gaps.
  • Conducted a scoping review per PRISMA-ScR guidelines
  • Searched multiple databases including PubMed and Embase
  • Included articles published in English, Spanish, and German regarding musculoskeletal pain and gender bias
  • Data extracted by two independent reviewers for bibliometric and study characteristics
  • 21 full-text articles included, all from North America and Europe
  • 3574 healthcare providers across various specialties examined
  • 57.1% of studies used written case vignettes to assess gender bias
  • Findings suggest male patients receive more exercise recommendations while female patients receive more psychological treatment recommendations
  • Inconsistent use of terms related to sex and gender noted in the literature.

Abstract

Objective Musculoskeletal pain is a global issue affecting millions of individuals. Healthcare provider gender bias (HCP-GB) in pain management or treatment may have implications. This study aimed to systematically (1) identify and map the scientific and grey literature as it relates to HCP-GB in the assessment, diagnosis and management of musculoskeletal pain, and (2) identify current gaps that necessitate further research. Design This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data sources The following databases were searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (EBSCOhost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022 and updated in May 2025. Relevant grey literature was identified. Eligibility criteria for selecting articles All screening was performed by two reviewers during title/abstract screening and full-text screening stages. Articles published in English, Spanish and German were included if they involved participants with musculoskeletal pain and examined HCP-GB as the dependent variable. Data extraction and synthesis Two reviewers independently extracted data from the bibliometric, study characteristics and pain science variables. Results were descriptively mapped, and the frequency of concepts, population and characteristics was narratively reported. Results 21 full-text articles were included. All articles were published in North America and Europe. A total of 3694 healthcare providers from various specialty areas were examined. A majority of studies (57.1%; n=12) measured HCP-GB using written case vignettes, 33.3% (n=7) used case vignettes plus virtual human pictures/videos, and 9.5% (n=2) used real patients. The influence of patients’ sex in HCP pain assessment was reported in 28.5% (n=6) of the articles, while 42.9% (n=9) reported gender bias regarding HCP non-pharmacological treatment recommendations. Male patients were more likely to receive exercise recommendations for back pain and laboratory testing, whereas female patients received more psychological treatment recommendations and counselling from their HCP. Conclusions While there appears to be inconsistent use of the terms sex and gender, the literature informing this review suggests an existence of gender bias in the management of patients with musculoskeletal pain. Future research should be more purposeful in the use of sex/gender-related terms and consider exploring the impact of implicit bias training to rectify potential gender biases present in HCP.

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Cite This Study

Wilford et al. (2026) studied this question.

synapsesocial.com/papers/6966f30613bf7a6f02c008b4https://doi.org/10.1136/bmjopen-2025-107766
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