Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries
Matt Fillingim, Christophe Tanguay-Sabourin, Lindsay Neuert, Azin Zare, Jax Norman, Gianluca V. Guglietti, Lise Hobeika, Abimbola Ayorinde, Ahmad Salimzadeh, Ahmad-reza Jamshidi, Aqeel M. Alenazi, Arash Tehrani-Banihashemi, Bader A. Alqahtani, Beatriz Olaya, Benjamin Longo Mbenza, Bibilola Oladeji, Brenda Penninx, Buddhi Paudyal, Caique de Melo, Chantal Berna, Clarissa Humberg, Pascal Claudepierre, Elisa Smith, Elizabeth VanDenKerkhof, Erik J. Giltay, Esther Garcia-Esquinas, Faisal Parlindungan, Fatima Qayyum Abbasi, Fernando Rodríguez Artalejo, Gareth T. Jones, Gary Slade, Hanifa Bouziri, Herta Flor, Hiroyasu Iso, Ian Gilron, Imad Uthman, Ingris Peláez-Ballestas, Jean-Paul Divengi Nzambi, Jose Luis Ayuso-Mateos, Josep Maria Haro, Julia Wager, Juliana Barcellos de Souza, Kazutoshi Nakamura, Keiko Yamada, Lisa-Marie Rau, Makram Talih, Marcus J. Beasley, María Dueñas, Marie Zins, Marta Miret, Melissa Wake, Mirza Zaka Pratama, Mohammed Almalki, Monique Chaaya, Muhammad Anshory, Naoki Kondo, Navid Moghadam, Norma Mansor, Omar Alsaed, Orawan Keeratisiroj, Oye Gureje, Pande Ketut Kurniari, Pardis Noormohammadpour, Pierrot Lebughe, Raga A. Elzahaf, Ramin Kordi, Raquel Lucas, Rashmi Parekh Bhandari, Rosa Weiss Telles, Rudy Hidayat, Saba Samreen, Samar Al-Emadi, Sandhi Maria Barreto, Shima RoknSharifi, Shinsuke Inoue, Sudeep Adhikari, Suryo Anggoro Kusumo Wibowo, Sweekriti Sharma, Sylvia Villeneuve, Takahiro Tabuchi, Tayyeba Khursheed, Tie Yamato, Todd Jackson, Veronica Souza Santos, Wantana Siritaratiwat, Xianchen Liu, Zhen-Zhen Liu, IMAGEN Consortium, Susan M. Sawyer, Saman Khalatbari-Soltani, Ólöf Anna Steingrímsdóttir, Gary J. Macfarlane, Fiona Blyth & Etienne Vachon-Presseau
Oktober, 2026
Abstract
Pain is the leading cause of disability worldwide, yet no harmonized self-reported reference framework exists to characterize how its burden is distributed across the lifespan and world regions. In this study, we harmonized individual-level self-reported pain data from 6,125,459 participants across 902 population-based data sources in 118 countries to establish global reference trajectories of pain. We implemented these trajectories in an open-access benchmarking platform for positioning external datasets against global pain norms. Pain prevalence ranged from roughly 2% for facial pain to 40% for back pain, was consistently higher in women across all 11 anatomical sites (risk ratio range: 1.08−1.83) and increased most steeply before age 55 years. Contrary to existing estimates that generally project higher prevalence of pain conditions in higher Human Development Index (HDI) regions, we found that individuals in the lowest HDI countries experienced a substantially higher late-life prevalence of any bodily pain than those in the highest (risk difference: 30.6 percentage points (95% confidence interval: 26.9−34.3)), with low back pain approaching twice the prevalence at the oldest ages. Globally, 18.3% of pain burden across anatomical sites was attributable to three modifiable risk factors (smoking, obesity and low income), but this varied from 12.6% in sub-Saharan Africa to 27.1% in eastern Europe, indicating that the factors underlying pain in lower-HDI settings remain poorly characterized. Together, these reference trajectories provide a common framework for defining and comparing pain burden and informing more equitable global surveillance and prevention.
