Pain doesn't simply get worse with age. A sweeping global study reveals why headaches and abdominal pain peak earlier in life, while back and joint pain often rise into old age, and why where you live may shape your experience of pain.
Study: Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries. Image credit: 1981 Rustic Studio kan/Shutterstock.com
Pain in most common anatomical sites increases most sharply before the age of 55 years and is consistently higher among women, according to a large-scale global analysis published in Nature Medicine.
Global study maps pain patterns across the life
Pain is a leading cause of disability worldwide. However, no objective biomarker exists to quantify it. Existing estimates, including the Global Burden of Disease (GBD) study, mostly rely on clinically defined conditions and modeled estimates from diverse data sources. Although this approach is essential for disease surveillance, it may overlook people who have limited access to healthcare.
Population-based studies routinely collect self-reported pain data to estimate its global prevalence. However, these databases lack systematic harmonization due to the use of diverse questionnaires, different timeframes, and varied anatomical definitions, making accurate estimation of global pain prevalence challenging.
The current study aimed to characterize the distribution of pain burden across the lifespan and global regions by analyzing self-reported pain data from 6,125,459 participants across 902 population-based data sources in 118 countries and territories. Participants were aged 5 to more than 100 years, and 55% were female. The contributing studies were conducted between 1990 and 2025.
Pain trajectories vary by age, sex, and region
The assessment of pain prevalence across 11 major anatomical sites showed that overall prevalence ranged from 2% for facial pain to 40% for back pain. The prevalence was consistently higher among women than men across all 11 sites. The largest gender differences were observed for facial pain, headache, and stomach or abdominal pain, with women reporting 83%, 74%, and 60% higher prevalence, respectively.
The most rapid increase in pain prevalence for musculoskeletal sites (back, hip, and knee) was observed between ages 20 and 55 years, with prevalence continuing to rise and reaching its highest levels at or beyond 75 years of age.
The age-specific estimation revealed that pain does not increase linearly with age; instead, pain at seven of the 11 anatomical sites peaks in mid-to-late adulthood and declines thereafter. This pattern is most pronounced for headache, abdominal pain, neck or shoulder pain, elbow pain, and facial pain.
Across most anatomical sites, pain prevalence increased most steeply before 55 years of age, suggesting that a substantial share of the population-level pain burden develops during early and middle adulthood.
However, the prevalence of any bodily pain increased progressively across the lifespan, from approximately 30% at age five to 70% at age 100 years or older. In contrast, high-intensity pain peaked around age 50, while generalized pain peaked around age 70, with both declining thereafter.
Estimation stratified by Human Development Index (HDI; a measure of a country’s average achievement in health, education, and standard of living) showed that from age 40 years, the prevalence of any bodily pain, joint pain, and back pain increased more steeply in countries with low HDI values. People in these countries experienced a substantially higher prevalence by age 80 years or above than their counterparts in countries with high-HDI values.
The prevalence of low back pain in low-HDI countries was nearly twofold higher than that in high-HDI countries at the oldest ages.
The risk factor analysis indicated that smoking, obesity, and low household income were associated with increased pain prevalence. The researchers estimated that these three modifiable or policy-relevant factors collectively accounted for approximately 18% of site-specific pain burden globally. However, the estimated attributable proportion varied from 12.6% in sub-Saharan Africa to 27.1% in eastern Europe, indicating that the factors underlying pain in lower-HDI countries remain poorly characterized.
Global pain patterns challenge assumptions about aging
The study provides global reference trajectories of pain across the lifespan with broad geographic coverage. These trajectories can be used to define and compare pain burden among individual cohorts, clinical populations, and countries.
The study finds that pain in several common anatomical sites, including headache, abdominal pain, and facial pain, peaks before the age of 55 years and declines thereafter, refining the common perception that pain increases unidirectionally with age. However, lower-body musculoskeletal pain, particularly back, hip, and knee pain, generally increases into older age, whereas upper-body pain, including neck, shoulder, and elbow pain, tends to peak earlier and subsequently decline.
Given these findings, the researchers suggest that pain prevention may need to start earlier in life and should be personalized for different anatomical sites.
The study's estimates stratified by global regions suggest a consistent pattern of early-life convergence and late-life divergence. For any bodily pain and joint pain, prevalence was broadly similar across regions in early adulthood but diverged substantially after age 65 years.
Specifically, countries with low HDI showed low pain prevalence in early adulthood, which increased sharply during mid-life and exceeded the global reference in older age. These findings suggest that broader conditions associated with national development, including access to healthcare, occupational exposures, and comorbidity burden, may potentially contribute to the trajectories of pain prevalence across the lifespan. The observed divergence of pain prevalence from the global reference in countries with low HDI highlights that the current global estimates are largely shaped by data from high-income countries.
Taken together, the reference trajectories developed in the study provide a common framework for defining and comparing pain burden and informing more equitable global surveillance and prevention.
Most datasets analyzed in the study were cross-sectional, and therefore the trajectories show differences between age groups rather than within-person differences. Furthermore, because cross-sectional surveys capture current or recent responses, the estimates should be interpreted as point or period prevalence rather than measures of persistent or chronic pain.
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