{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:59:10Z","timestamp":1792684750928,"version":"4.5.0"},"reference-count":68,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,3]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria for selecting articles<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107766","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:31:17Z","timestamp":1768231877000},"page":"e107766","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["International perspective on healthcare provider gender bias in musculoskeletal pain management: a scoping review"],"prefix":"10.1136","volume":"16","author":[{"given":"Katherine F","family":"Wilford","sequence":"first","affiliation":[{"name":"Physical Therapy Program, Murphy Deming College of Health Sciences, Mary Baldwin University, Fishersville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jesus","family":"Mena-Iturriaga","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Cl\u00ednica Alemana, Universidad del Desarrollo, Santiago, Santiago Metropolitan Region, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Vugrin","sequence":"additional","affiliation":[{"name":"Preston Smith Library, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macarena","family":"Wainer","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Cl\u00ednica Alemana, Universidad del Desarrollo, Santiago, Santiago Metropolitan Region, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3343-9151","authenticated-orcid":false,"given":"Gesine H","family":"Seeber","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, Division of Orthopedics at Campus Pius-Hospital, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"},{"name":"University Medical Center Groningen, Department of Orthopedics, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026011207303295000_16.1.e107766.1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001939"},{"key":"2026011207303295000_16.1.e107766.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.13805"},{"key":"2026011207303295000_16.1.e107766.3","doi-asserted-by":"crossref","first-page":"e670","DOI":"10.1016\/S2665-9913(23)00232-1","article-title":"Global, regional, and national burden of other musculoskeletal disorders, 1990\u20132020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"5","author":"Gill","year":"2023","journal-title":"The Lancet Rheumatology"},{"key":"2026011207303295000_16.1.e107766.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.1532","article-title":"The Cost of Pain","volume":"2","author":"Smith","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026011207303295000_16.1.e107766.5","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/S0140-6736(21)00393-7","article-title":"Chronic pain: an update on burden, best practices, and new advances","volume":"397","author":"Cohen","year":"2021","journal-title":"The Lancet"},{"key":"2026011207303295000_16.1.e107766.6","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/S2215-0366(19)30288-3","article-title":"Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors","volume":"7","author":"Kirtley","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2026011207303295000_16.1.e107766.7","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001384"},{"key":"2026011207303295000_16.1.e107766.8","unstructured":"Dydyk AM , Pain CTC . Chronic pain.2025. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK553030\/ [accessed 16 Apr 2025]."},{"key":"2026011207303295000_16.1.e107766.9","doi-asserted-by":"crossref","DOI":"10.1007\/s11920-020-01149-0","article-title":"Identification and Management of Opioid Use Disorder in Primary Care: an Update","volume":"22","author":"Donroe","year":"2020","journal-title":"Curr Psychiatry Rep"},{"key":"2026011207303295000_16.1.e107766.10","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1097\/AJP.0000000000000855","article-title":"Increased Experimental Pain Sensitivity in Chronic Pain Patients Who Developed Opioid Use Disorder","volume":"36","author":"Compton","year":"2020","journal-title":"Clin J Pain"},{"key":"2026011207303295000_16.1.e107766.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2007.02.432"},{"key":"2026011207303295000_16.1.e107766.12","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-152-2-201001190-00006"},{"key":"2026011207303295000_16.1.e107766.13","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.21998"},{"key":"2026011207303295000_16.1.e107766.14","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31802b4f95"},{"key":"2026011207303295000_16.1.e107766.15","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31816b1070"},{"key":"2026011207303295000_16.1.e107766.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-059233","article-title":"International perspective on healthcare provider gender bias in musculoskeletal pain management: a scoping review protocol","volume":"12","author":"Wilford","year":"2022","journal-title":"BMJ Open"},{"key":"2026011207303295000_16.1.e107766.17","unstructured":"American Physical Therapy Association (APTA) . Guide to phsical therapist practice. American Physical Therapy Association; 2021. Available: https:\/\/guide.apta.org\/"},{"key":"2026011207303295000_16.1.e107766.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2021.03.001"},{"key":"2026011207303295000_16.1.e107766.19","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s00482-015-0046-9","article-title":"Muskuloskeletaler Schmerz","volume":"29","author":"Casser","year":"2015","journal-title":"Schmerz"},{"key":"2026011207303295000_16.1.e107766.20","unstructured":"Maitland G , Hengeveld E , Banks K , et al . Chatper 3: communication. In: Maitland\u2019s vertebral manipulation. 4th edn. Edinburgh: Elsevier, 2005."},{"key":"2026011207303295000_16.1.e107766.21","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-psych-122216-011719"},{"key":"2026011207303295000_16.1.e107766.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2007.08.007"},{"key":"2026011207303295000_16.1.e107766.23","doi-asserted-by":"crossref","unstructured":"FitzGerald C , Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18. doi:10.1186\/s12910-017-0179-8","DOI":"10.1186\/s12910-017-0179-8"},{"key":"2026011207303295000_16.1.e107766.24","unstructured":"Bever L . From heart disease to IUDs: how doctors dismiss women\u2019s pain. The Washington post; 2023. Available: https:\/\/www.washingtonpost.com\/wellness\/interactive\/2022\/women-pain-gender-bias-doctors\/"},{"key":"2026011207303295000_16.1.e107766.25","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001165"},{"key":"2026011207303295000_16.1.e107766.26","doi-asserted-by":"crossref","unstructured":"Samulowitz A , Gremyr I , Eriksson E , et al . \u201cBrave Men\u201d and \u201cEmotional Women\u201d: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag 2018;2018. doi:10.1155\/2018\/6358624","DOI":"10.1155\/2018\/6358624"},{"key":"2026011207303295000_16.1.e107766.27","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1097\/j.pain.0000000000000536","article-title":"Health care providers\u2019 judgments in chronic pain: the influence of gender and trustworthiness","volume":"157","author":"Sch\u00e4fer","year":"2016","journal-title":"Pain"},{"key":"2026011207303295000_16.1.e107766.28","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2340\/16501977-1936","article-title":"Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?","volume":"47","author":"St\u00e5lnacke","year":"2015","journal-title":"J Rehabil Med"},{"key":"2026011207303295000_16.1.e107766.29","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/AJP.0000000000000824","article-title":"Sex Bias and Genotype Influence on Opioid Safety Profile in Chronic Low Back Pain","volume":"36","author":"Margarit","year":"2020","journal-title":"Clin J Pain"},{"key":"2026011207303295000_16.1.e107766.30","unstructured":"Government of Canada . What is gender? what is sex? Canadian Institutes of Health Research; 2024. Available: https:\/\/cihr-irsc.gc.ca\/e\/48642.html"},{"key":"2026011207303295000_16.1.e107766.31","unstructured":"National Academies of Sciences, Engineering and Medicine . Measuring sex, gender identity, and sexual orientation. Washington, DC: The National Academies Press, 2022."},{"key":"2026011207303295000_16.1.e107766.32","doi-asserted-by":"publisher","DOI":"10.1080\/13645579.2020.1819518"},{"key":"2026011207303295000_16.1.e107766.33","doi-asserted-by":"crossref","unstructured":"Peters M , Godfrey C , McInerney P , et al . Chapter 11: scoping reviews (2020 version). In: Aromataris E , Munn Z , eds. JBI Manual for evidence synthesis. JBI, 2020.","DOI":"10.46658\/JBIRM-20-01"},{"key":"2026011207303295000_16.1.e107766.34","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"2026011207303295000_16.1.e107766.35","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-20-00167"},{"key":"2026011207303295000_16.1.e107766.36","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026011207303295000_16.1.e107766.37","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1186\/s12891-020-03257-7","article-title":"Inconsistent descriptions of lumbar multifidus morphology: A scoping review","volume":"21","author":"Hofste","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"2026011207303295000_16.1.e107766.38","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000002618"},{"key":"2026011207303295000_16.1.e107766.39","doi-asserted-by":"publisher","DOI":"10.1002\/msc.1497"},{"key":"2026011207303295000_16.1.e107766.40","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2024-108617"},{"key":"2026011207303295000_16.1.e107766.41","doi-asserted-by":"publisher","DOI":"10.1089\/152460902760360595"},{"key":"2026011207303295000_16.1.e107766.42","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.pmn.2022.03.008","article-title":"The Impact of Sexism and Gender Stereotypes on the Legitimization of Women\u2019s Low Back Pain","volume":"23","author":"Prego-Jimenez","year":"2022","journal-title":"Pain Manag Nurs"},{"key":"2026011207303295000_16.1.e107766.43","doi-asserted-by":"crossref","unstructured":"Schilter LV , Le Boudec JA , Hugli O , et al . Gender-based differential management of acute low back pain in the emergency department: A survey based on a clinical vignette. Womens Health (Lond) 2024;20. doi:10.1177\/17455057231222405","DOI":"10.1177\/17455057231222405"},{"key":"2026011207303295000_16.1.e107766.44","doi-asserted-by":"publisher","DOI":"10.1515\/jom-2021-0229"},{"key":"2026011207303295000_16.1.e107766.45","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(95)70107-9"},{"key":"2026011207303295000_16.1.e107766.46","first-page":"206","article-title":"Do nurse anesthetists demonstrate gender bias in treating pain? A national survey using a standardized pain model","volume":"71","author":"Criste","year":"2003","journal-title":"J Am Assoc Nurse Anesth"},{"key":"2026011207303295000_16.1.e107766.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2013.09.011"},{"key":"2026011207303295000_16.1.e107766.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2003.08.002"},{"key":"2026011207303295000_16.1.e107766.49","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/j.0022-0337.2016.80.5.tb06118.x","article-title":"Assessment of the Influence of Demographic and Professional Characteristics on Health Care Providers\u2019 Pain Management Decisions Using Virtual Humans","volume":"80","author":"Boissoneault","year":"2016","journal-title":"J Dent Educ"},{"key":"2026011207303295000_16.1.e107766.50","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/pme.12591","article-title":"The influence of health care professional characteristics on pain management decisions","volume":"16","author":"Bartley","year":"2015","journal-title":"Pain Med"},{"key":"2026011207303295000_16.1.e107766.51","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1097\/BRS.0b013e3181fee8ef","article-title":"Managing nonspecific low back pain: do nonclinical patient characteristics matter?","volume":"36","author":"Weiner","year":"1976","journal-title":"Spine (Phila Pa 1986)"},{"key":"2026011207303295000_16.1.e107766.52","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016004211.x"},{"key":"2026011207303295000_16.1.e107766.53","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/scs.12312","article-title":"Walking down \u201cVia Dolorosa\u201d from primary health care to the specialty pain clinic - patient and professional perceptions of inequity in rehabilitation of chronic pain","volume":"31","author":"Lehti","year":"2017","journal-title":"Scand J Caring Sci"},{"key":"2026011207303295000_16.1.e107766.54","doi-asserted-by":"publisher","DOI":"10.1054\/jpai.2003.5"},{"key":"2026011207303295000_16.1.e107766.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2014.02.003"},{"key":"2026011207303295000_16.1.e107766.56","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.ejpain.2011.03.010","article-title":"On the contextual nature of sex-related biases in pain judgments: the effects of pain duration, patient\u2019s distress and judge\u2019s sex","volume":"15","author":"Bernardes","year":"2011","journal-title":"Eur J Pain"},{"key":"2026011207303295000_16.1.e107766.57","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1080\/08870446.2011.553680","article-title":"A contextual approach on sex-related biases in pain judgements: the moderator effects of evidence of pathology and patients\u2019 distress cues on nurses\u2019 judgements of chronic low-back pain","volume":"26","author":"Bernardes","year":"2011","journal-title":"Psychol Health"},{"key":"2026011207303295000_16.1.e107766.58","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/pme.12506","article-title":"Impact of race and sex on pain management by medical trainees: a mixed methods pilot study of decision making and awareness of influence","volume":"16","author":"Hollingshead","year":"2015","journal-title":"Pain Med"},{"key":"2026011207303295000_16.1.e107766.59","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1002\/j.1532-2149.2013.00355.x","article-title":"The influence of patient\u2019s sex, race and depression on clinician pain treatment decisions","volume":"17","author":"Hirsh","year":"2013","journal-title":"Eur J Pain"},{"key":"2026011207303295000_16.1.e107766.60","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198106000-00004"},{"key":"2026011207303295000_16.1.e107766.61","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/S0140-6736(20)32346-1","article-title":"Analysing how sex and gender interact","volume":"396","author":"Stefanick","year":"2020","journal-title":"Lancet"},{"key":"2026011207303295000_16.1.e107766.62","unstructured":"Government of Canada. Canadian Institutes of Health Research . What is gender? What is sex?, 2025. Available: https:\/\/cihr-irsc.gc.ca\/e\/48642.html"},{"key":"2026011207303295000_16.1.e107766.63","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.3390\/ijms24031866","article-title":"The Role of Sex Hormones in Pain-Related Conditions","volume":"24","author":"Athnaiel","year":"2023","journal-title":"IJMS"},{"key":"2026011207303295000_16.1.e107766.64","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1080\/17437199.2020.1813602","article-title":"The gender context of pain","volume":"15","author":"Keogh","year":"2021","journal-title":"Health Psychol Rev"},{"key":"2026011207303295000_16.1.e107766.65","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302903"},{"key":"2026011207303295000_16.1.e107766.66","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s40670-022-01673-z","article-title":"Implicit Bias Training in Health Professions Education: A Scoping Review","volume":"32","author":"Mavis","year":"2022","journal-title":"Med Sci Educ"},{"key":"2026011207303295000_16.1.e107766.67","doi-asserted-by":"crossref","DOI":"10.1080\/10872981.2021.2025307","article-title":"Brief online implicit bias education increases bias awareness among clinical teaching faculty","volume":"27","author":"Sabin","year":"2022","journal-title":"Med Educ Online"},{"key":"2026011207303295000_16.1.e107766.68","doi-asserted-by":"crossref","unstructured":"Guzikevits M , Gordon-Hecker T , Rekhtman D , et al . Sex bias in pain management decisions. Proc Natl Acad Sci USA 2024;121. doi:10.1073\/pnas.2401331121","DOI":"10.1073\/pnas.2401331121"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:31:36Z","timestamp":1768231896000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjopen-2025-107766"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107766","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}