Սեռային տարբերությունները աշխատունակության սահմանափակման մեջ քրոնիկ գոտկային ցավ ունեցող Հայաստանի բնակչության շրջանում. լայնական հետազոտություն Օսվեստրիի գոտկային ցավով պայմանավորված աշխատունակության սահմանափակման հարցաշարի հիման վրա

Chronic back pain (CBP) is a major cause of disability worldwide, impacting individual well-being and public health systems. The World Health Organization has identified back pain as a leading cause of global disability [1]. Despite a wealth of research on CBP, limited data exist concerning gender-specific patterns in pain perception and functional limitations, particularly in the Armenian context.

Pain experience is known to be influenced by both biological sex and gender roles. Literature suggests that women often report greater pain intensity and disability, while men might delay care-seeking and underreport functional limitations [2]. Understanding these differences is vital for designing effective, individualized treatment strategies.

Gender-sensitive clinical practices aim to address disparities in healthcare experience and outcomes. However, current management protocols for CBP often neglect these nuances. Local studies exploring this aspect of pain and disability are essential to formulating effective care models.

Addressing this gap, the present study explores gender-based variations in disability among Armenian patients with CBP, employing the Oswestry Low Back Pain Disability Questionnaire, also known as Oswestry Disability Index (ODI) – a validated and widely used tool for assessing spine-related functional impairment [3].

METHODS

This cross-sectional study was conducted between 2022 and 2023 in three multidisciplinary medical centers in Armenia. Inclusion criteria were adults aged 18-75 with CBP lasting more than 3 months and no prior spinal surgery.

Participants completed the validated Armenian version of ODI, which consists of 10 sections: Pain Intensity, Personal Care, Lifting, Walking, Sitting, Standing, Sleeping, Social Life, Traveling, and Employment/Homemaking. Each section is scored from 0 to 5, yielding a total score that is converted to a percentage representing overall disability (minimal to immobilized).

To ensure data quality, all questionnaires were checked for completeness by trained research staff. Participants were informed about the purpose and voluntary nature of the study. Ethical approval was granted by the institutional review board of each participating center.

Statistical analysis was performed using SPSS v26. Descriptive statistics (means±standard deviations) were calculated. Gender comparisons for ODI domains were evaluated using independent two-sample t-tests assuming unequal variance.

RESULTS

A total of 1562 participants were enrolled in this study (967 females 61.9%, and 595 males) with a mean age of 48.2±10.4 years. The study population represented a broad range of employment types, socioeconomic backgrounds, and education levels. Pain duration ranged from 3 months to over 5 years. Most participants were employed at the time of the study, though a substantial proportion of women were homemakers or engaged in part-time caregiving duties.

Men reported significantly higher pain intensity, while women reported greater limitations in self-care and lifting tasks (Table 1). These differences may reflect occupational roles, health-seeking behaviors, and sociocultural expectations regarding expression of vulnerability and dependency. Additional domains, such as walking, sitting, and sleeping, exhibited comparable scores between genders, with minor nonsignificant trends toward greater disruption among women.

DISCUSSION

The results of our survey showed there were notable gender differences in CBP-related disability among Armenian patients. Men reported higher pain intensity scores, while women experienced more functional impairment in activities. Although experience of pain may be stronger in men, women’s daily functional limitations are more significant [4,5].

Chronic back pain is a complex, multifactorial condition with biopsychosocial underpinnings. Numerous studies have explored the epidemiology, pathophysiology, and treatment modalities of CBP, yet relatively few have addressed gender-specific differences in pain experience and disability outcomes.

A growing body of evidence highlights distinct gender differences in pain perception and reporting. Women consistently report higher pain sensitivity and greater pain-related disability across a variety of chronic pain conditions, including CBP. These differences are believed to stem from both physiological factors, such as hormonal fluctuations and differences in endogenous pain modulation, and sociocultural influences that shape pain expression. Functional impairment due to CBP also appears to vary by gender. A meta-analysis by Alabas et al. (2012) reported that women with CBP showed significantly higher scores on disability indices, particularly in domains related to personal care and mobility [5]. This may be partly attributable to the dual burden of paid labor and unpaid caregiving roles often undertaken by women, amplifying the functional impact of chronic pain [6].

Conversely, men may underreport disability due to societal expectations that discourage vulnerability and dependence. Studies such as those by Racine et al. (2012) suggest that masculine norms can lead to delayed healthcare-seeking behaviors, potentially exacerbating long-term outcomes [7].

The ODI remains one of the most commonly used tools for evaluating functional disability in individuals with CBP. However, it is not inherently gender-sensitive, and researchers have raised concerns about its ability to capture gendered experiences of disability fully. Despite this, the ODI continues to provide a standardized framework for comparative analysis, especially when supplemented by large, representative samples. While international literature has increasingly addressed sex and gender differences in pain, data from low- and middle-income countries, including Armenia, remain sparse. In the Armenian context, no large-scale studies to date have examined gender-based variation in CBP-related disability using validated tools [8].

The integration of gender-sensitive practices in chronic pain management is increasingly recommended by global health authorities. The International Association for the Study of Pain (IASP) has issued calls for gender-inclusive research and treatment design. However, a gap remains between policy advocacy and clinical implementation, particularly in resource-limited settings [9].

By analyzing gender differences in ODI domains among Armenian CBP patients, the present study aimed to inform a more inclusive and responsive model of pain care, one that addresses the unique experiences and needs of both men and women.

This study demonstrates distinct gender differences in CBP-related disability within an Armenian population. Contrary to some international findings, Armenian men reported greater pain intensity. This could be due to cultural acceptability of expressing pain when it affects work-related or physically demanding tasks. Additionally, men in this study may have been more likely to be engaged in manual labor, further increasing perceived pain intensity.

Women showed greater disability in personal care and lifting domains. These findings may be influenced by societal roles and expectations, with women often assuming more caregiving and domestic duties, potentially exacerbating physical strain. Tasks like bathing, dressing, or carrying loads may disproportionately burden women with chronic pain. These responsibilities may compound the physical limitations imposed by back pain and contribute to feelings of reduced independence or productivity.

The ODI is effective in capturing such differences due to its coverage of both physical and psychosocial aspects. Each domain reflects real-world functional impairments, enabling clinicians to identify specific gender-based challenges in CBP. Importantly, domains like sleeping and social life, although not statistically significant in this study, can still inform holistic treatment plans. Incorporating patient-centered approaches that consider lifestyle, caregiving burdens, and role identity may enhance the effectiveness of pain management interventions.

Our findings align with prior research demonstrating gender differences in pain-related disability. For example, studies have shown women to be more susceptible to central sensitization and emotional amplification of pain symptoms. On the other hand, men may be more likely to internalize pain due to stigma or societal conditioning, which may delay treatment but increase the severity at presentation. Additionally, men may seek help only when pain interferes with work or physical activity, potentially skewing results toward higher pain intensity.

The implications of this study are twofold. Clinicians should incorporate gender-aware approaches in patient evaluation and care planning. Tailored physical therapy programs, psychosocial support, and patient education can enhance engagement and outcomes across genders. At the same time, health policy must ensure equitable access to rehabilitation services that accommodate gender-specific needs and responsibilities. For instance, access to in-home care support or flexible work accommodations may be especially beneficial for female patients.

Limitations include the cross-sectional design, which restricts causal inference, and the reliance on self-reported data, which may be influenced by recall or reporting bias. Furthermore, the ODI, while comprehensive, may not fully capture gendered experiences or the influence of psychological comorbidities. Future research could benefit from a longitudinal approach and inclusion of psychological variables such as pain catastrophizing, anxiety, or coping style. Qualitative studies exploring lived experiences of pain and disability across genders could also provide valuable context to support quantitative findings.

CONCLUSION

Gender-specific patterns in CBP-related disability are evident in the Armenian population. While men report more pain, women show higher disability in functional tasks like self-care and lifting. These differences highlight the need for personalized, gender-aware pain management and rehabilitation approaches.

Clinicians should utilize gender-sensitive tools, such as the ODI, to guide assessment and tailor interventions. Given the widespread prevalence and burden of CBP, addressing gender disparities in disability is essential for improving overall health outcomes and resource allocation in Armenia and similar settings. Ultimately, recognizing gender-based functional limitations can lead to more empathetic care delivery and better quality of life for patients affected by chronic back pain.

Table 1. Oswestry Disability Index domain comparison by gender.

References

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