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A study using self-reported data from more than 6.1 million people in 118 countries found that pain does not rise uniformly with age: back, hip and knee pain generally increase into older age, while several other types peak earlier. Pain prevalence was higher among women across all 11 sites studied, and back and joint pain rose more steeply after age 40 in lower-HDI countries.
A global analysis of 6.1 million people across 118 countries and territories finds that pain follows different age patterns depending on the body site, with back, hip and knee pain generally increasing into older age while several other forms peak earlier. Published in Nature Medicine, the study also reports higher pain prevalence among women at all 11 anatomical sites examined, and sharper rises in back and joint pain after age 40 in countries with lower Human Development Index scores.
The researchers analyzed self-reported pain information from 6,125,459 participants in 902 population-based data sources. Participants ranged from age five to over 100, 55% were female, and the underlying studies were conducted between 1990 and 2025. The analysis grouped pain across 11 anatomical sites and compared estimates by age, sex and country-level development measures.
Across those sites, estimated prevalence ranged from 2% for facial pain to 40% for back pain. Women had higher reported prevalence than men at every site. The largest differences were for facial pain, headache and stomach or abdominal pain: women’s prevalence was 83%, 74% and 60% higher, respectively, according to the study.
Age patterns differed. Back, hip and knee pain rose most rapidly between ages 20 and 55 and reached their highest levels at or after age 75. By contrast, pain at seven of the 11 sites peaked in mid-to-late adulthood and then declined. Headache, abdominal, neck or shoulder, elbow and facial pain showed this pattern most clearly. The researchers also estimated that any bodily pain increased from about 30% at age five to 70% among people aged 100 or older, while high-intensity pain peaked around 50 and generalized pain around 70 before declining.
Pain Risks Diverge in Older Age
The findings show that pain does not increase at the same rate across all body sites as people age. The study describes distinct trajectories: some pain types are more prevalent earlier in adulthood, while lower-body musculoskeletal pain tends to persist or become more prevalent at older ages. These patterns may inform how population health services track pain and assess its prevalence across age groups.
Country-level differences add another dimension. From age 40, estimates for any bodily pain, joint pain and back pain rose more steeply in lower-HDI countries than in higher-HDI countries. At the oldest ages, low-back pain prevalence in lower-HDI countries was nearly twice that in high-HDI countries. The study identifies a pattern in which estimates are broadly similar across regions in early adulthood, then diverge after about age 65.
The authors also examined smoking, obesity and low household income. They estimated that these factors together accounted for about 18% of site-specific pain burden globally. This is a modeled attribution, not proof that the factors caused the reported pain, and the estimated share varied by region. The study reports these factors as possible contributors for further investigation.
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Why Global Pain Estimates Differ
Pain is a major contributor to disability, but there is no objective biomarker that measures it across people and settings. Large-scale estimates such as the Global Burden of Disease study often rely on clinically defined conditions and modeled inputs. The researchers say that approach is useful for disease surveillance but may miss people with limited access to health care.
Population surveys can capture pain reported by people outside clinical settings, yet their results are difficult to compare when they use different questionnaires, recall periods and definitions of body regions. This study’s purpose was to combine such data into global and regional reference curves across age and anatomical sites. Those curves could provide a basis for comparisons among countries, cohorts and clinical populations, but they do not eliminate the limitations of the underlying surveys.
The study’s age and regional patterns also need to be read as population estimates, not predictions for an individual. The analysis combines data gathered over 35 years, during which survey methods, health services and population conditions could differ. Its results describe reported prevalence in the assembled sources; they do not establish why a person experiences pain or how a particular case will change over time.
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Limits of the Pain Comparisons
The report describes harmonization challenges in the source data, including differences in survey questions, timeframes and anatomical definitions. Although the researchers combined data from 902 sources, the supplied report does not detail how every difference was resolved or how much those differences may affect estimates for each country and age group.
The reasons for the sharper late-life increases in lower-HDI countries are also not established. The study suggests that broader conditions associated with national development may be relevant, but it does not identify a complete set of explanations. Researchers said factors underlying pain in lower-HDI countries remain poorly characterized. The reported associations with smoking, obesity and household income do not show that those factors alone account for regional differences.
Because the analysis draws on population data collected between 1990 and 2025, the estimates bring together different periods and survey settings. The provided report does not specify whether each country contributed comparable data at every age, nor does it give enough detail to judge how representative all estimates are of current populations. Those points limit how precisely the curves can be applied to any one country or group.
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How Researchers May Use the Curves
The study presents its reference curves as a resource for comparing pain burden across populations and clinical groups. Further work could test how well the estimates hold when applied to individual national datasets and examine the reasons for the late-life gaps between lower- and higher-HDI countries. More consistent survey questions and reporting periods could also make future international comparisons easier to interpret.
The researchers argue that prevention may need to begin earlier in life and be tailored to the site of pain. The study itself does not test a prevention program or establish which interventions would work. Further research could investigate the causes of regional differences and whether changes in risk factors or living conditions alter pain trajectories over time.
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Key Questions
What did the study find about pain and aging?
Pain does not rise uniformly with age. Back, hip and knee pain generally increased into older age, while several other types—including headache and abdominal pain—peaked earlier and then declined in the estimates.
How many people and countries were included?
The analysis covered 6,125,459 participants from 902 population-based data sources in 118 countries and territories. The source studies were conducted from 1990 to 2025.
Did the study find differences between women and men?
Yes. Reported pain prevalence was higher among women than men at all 11 anatomical sites. The largest relative differences were for facial pain, headache and stomach or abdominal pain.
What does the study say about country-level differences?
From age 40, any bodily pain, joint pain and back pain increased more steeply in countries with lower Human Development Index scores. At the oldest ages, estimated low-back pain prevalence in those countries was nearly twice the level in high-HDI countries.
Does the study explain why pain differs by age and country?
Not fully. It reports patterns and associations, including links with smoking, obesity and low household income, but does not establish the causes of the regional gaps. The authors describe the factors underlying pain in lower-HDI countries as poorly characterized.
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