Women report suffering more pain than men across the body, according to a major global study published in Nature Medicine. The finding held for all types of pain measured and adds to ongoing concern about the gender pain gap, which means women are less likely to be prescribed the pain relief they need.
Researchers from around the world carried out what they described as “one of the largest harmonization efforts in pain epidemiology to date”. Data was collected from more than 6 million people in 118 countries from 1990 to 2025, including individuals aged from five years old to more than 100.
Pain across the lifespan
The research examined how pain, as the leading global cause of disability, was distributed both around the world and across the human lifespan. It found that women’s self-reported pain across 11 bodily sites – head, face, neck or shoulder, foot or ankle, hand or wrist, elbow, chest, back, stomach or abdomen, hip and knee – was higher than for men. This was particularly true for headache, facial and abdominal pain.
For both men and women, the steepest increase in pain occurred before people turned 55, then peaked at or beyond 75, with back, hip and knee pain increasing across the lifespan. The authors wrote that this indicated “that a substantial share of lifetime pain burden develops during working-age adulthood”.
Key findings and regional differences
Roughly 40% of participants reported back pain, while facial pain was the rarest at 2%. Those in the lowest Human Development Index regions had substantially “higher late-life prevalence of bodily pain”, and almost twice the rates of low back pain in their older age. High-intensity pain peaked at about 50, while generalised pain peaked around 70.
“Overall, our results suggest that, although the likelihood of experiencing any pain rises steadily with age, the most disabling forms of pain followed an inverted-U trajectory, peaking in mid-to-late adulthood before declining,” the study authors wrote. “This distinction, between pain accumulation and pain that intensifies and then resolves, has direct implications for where prevention and care should be concentrated across the lifespan.”
The authors noted that current estimates focus on diagnoses, which may mean people with limited healthcare access are left out, which is why they analysed rates of self-reported pain. They wrote that this could provide a foundation for more equitable monitoring and prevention efforts.
Pain trajectories and contributing factors
“Trajectories varied markedly by phenotype: headache, abdominal and facial pain peaked earlier in life before declining, whereas musculoskeletal pain generally rose progressively with age,” they wrote. “Within musculoskeletal sites, upper body pain (including neck, shoulder and elbow) peaked around midlife and declined thereafter, whereas lower body pain (including back, hip and knee) continued to increase across the lifespan, consistent with the greater role of cumulative mechanical and degenerative load at weight-bearing sites.”
The study found that 18.3% of the global pain burden was due to smoking, obesity and low household incomes. This ranged from 12.6% in sub-Saharan Africa to 27.1% in eastern Europe. In Oceania, 6.6% of pain was attributable to smoking compared with 2.5% in sub-Saharan Africa and 8.5% in eastern Europe, while 11.2% of pain was attributable to obesity, compared with 2.7% in central and southern Asia and 14.6% in North America. Additionally, 8% was attributable to lower incomes, compared with 6.6% in sub-Saharan Africa and 8.6% in eastern Europe.
The authors noted important limitations on the research that could affect interpretations but did not alter the overall patterns. These included different ways of measuring pain, uneven coverage across different regions and oldest and youngest age groups, and that they described patterns for particular age groups rather than following the same people over time.
Professor Andrew Horne, director of the Centre for Reproductive Health at the University of Edinburgh in the UK, described the research as a landmark study, showing that women experience more pain than men at every body site studied. “Pain also rises most steeply before age 55, during women’s working, caring and reproductive years. It is strong evidence that the gender pain gap is real, consistent and global. Yet women’s pain is still too often dismissed, under-researched and under-treated,” he said. “Closing the gap means taking women’s pain seriously in the clinic, routinely analysing data by sex, properly funding research into the biological and social causes, and developing better, more personalised treatments for women.”
Prof Rebeccah Slater, professor of Paediatric Neuroscience at the University of Oxford, agreed. “The troubling paradox is that women experience more pain, yet their pain is also more likely to be dismissed, diagnosed late or undertreated,” she said. “This enormous study shows that the higher burden of pain in women is remarkably consistent across the body and in a remarkably diverse global population.”
