Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries

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.

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Publication Details

Journal
Nature Medicine
Published
2026-10-05
DOI
https://doi.org/10.1038/s41591-026-04696-w
Primary Topic
Musculoskeletal pain and rehabilitation
Type
article
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article

Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries

Sylvane Desrivières, Gianluca V. Guglietti, Pierrot Litite Lebughe, Ian Gilron et al.
Nature Medicine
Musculoskeletal pain and rehabilitation
article

Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries

Sylvane Desrivières, Gianluca V. Guglietti, Pierrot Litite Lebughe, Ian Gilron, Elizabeth G. VanDenKerkhof, Abimbola Ayorinde, Sandhi Maria Barreto, Navid Moghadam, Monique Chaaya, Rüdiger Brühl, Aqeel M. Alenazi, Bader Ali Alqahtani, Raga A. Elzahaf, Bibilola Damilola Oladeji, Chantal Berna, Tobias Banaschewski, Erik J. Giltay, Pascal Claudepierre, Julia Wager, Suryo Anggoro Kusumo Wibowo, Orawan Keeratisiroj, Christophe Tanguay-Sabourin, Oye Gureje, Rudy Hidayat, Azin Zare, Muhammad Anshory, Jean‐Luc Martinot, Marie‐Laure Paillère Martinot, Omar Suhail Alsaed, Josep María Haro, Caíque Melo, Arun L.W. Bokde, Samar A. Al-Emadi, Saba Samreen, Rosa Weiss Telles, Wantana Siritaratiwat, Takahiro Tabuchi, Juliana Barcellos de Souza, Herta Flor, Rashmi Parekh Bhandari, Faisal Parlindungan, Lisa‐Marie Rau, Antoine Grigis, Mohammed Almalki, María Dueñas, Pardis Noormohammadpour, Esther García‐Esquinas, Norma Binti Mansor, Brenda W.J.H. Penninx, Matt Fillingim, Buddhi Prasad Paudyal, Lise Hobeika, Raquel Lucas, Gareth T. Jones, Melissa A Wake, Hervé Lemaître, Pande Ketut Kurniari, Makram Talih, Benjamin Longo Mbenza, Shima Roknsharifi, Sweekriti Sharma, Beatriz Olaya, Arash Tehrani‐Banihashemi, Hanifa Bouziri, Marta Miret, Frauke Nees, Marie Zins, Ahmad Salimzadeh, Ramin Kordi, Sudeep Adhikari, Gareth J. Barker, Hiroyasu Iso, José Luís Ayuso‐Mateos, Jax Norman, Todd Jackson, Sylvia Villeneuve, Penny Anne Gowland, Éric Artiges, Kazutoshi Nakamura, Ingris del Pilar Peláez-Ballestas, Imad W. Uthman, Marcus Beasley, Ahmad-reza Jamshidi, Mirza Zaka Pratama, Clarissa Humberg, Fatima Qayyum Abbasi, Fernando Rodríguez Artalejo, Lindsay Neuert, XIANCHEN LIU, Gary Douglas Slade, Tayyeba Khursheed, Elisa Smith, Naoki Kondo, Shinsuke Inoue, Jean-Paul Divengi Nzambi, Veronica Souza Santos, Keiko Yamada, Tie Yamato, Andreas Heinz, Zhen-Zhen Liu
article en

Abstract

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.

Nature Medicine
Universidade Federal de Minas Gerais (BR), University of North Carolina at Chapel Hill (US), Universitat Autònoma de Barcelona (ES), Udayana University (ID), Physikalisch-Technische Bundesanstalt (DE), The University of Sydney (AU), Patan Academy of Health Sciences (NP), University of Nottingham (GB), Prince Sattam Bin Abdulaziz University (SA), Foundation University Islamabad (PK), Shandong University (CN), Witten/Herdecke University (DE), Iran University of Medical Sciences (IR), Universidade do Estado de Santa Catarina (BR), The University of Melbourne (AU), University of Brawijaya (ID), Khon Kaen University (TH), University of Ibadan (NG), Universidade do Porto (PT), King's College London (GB), University of Aberdeen (GB), Université Paris-Est Créteil (FR), Tohoku University (JP), University of Macau (MO), Queen's University (CA), Université Paris Cité (FR), Trinity College Dublin (IE), Kyoto University (JP), Heidelberg University (DE), University of Tripoli (LY), Université Paris-Saclay (FR), Leiden University Medical Center (NL), Instituto de Salud Carlos III (ES), Hospital General de México (MX), University of Indonesia (ID), University of Malaya (MY), Juntendo University (JP), University of Kinshasa (CD), Universidad de Cádiz (ES), University of Warwick (GB), Universidade Cidade de São Paulo (BR), Central Institute of Mental Health (DE), Changchun University of Chinese Medicine (CN), Parc Sanitari Sant Joan de Déu (ES), Stanford Medicine (US), Amsterdam University Medical Centers (NL), Oxford University Clinical Research Unit Nepal, Institute of Public Health, University of Porto (PT), Hamad Medical Corporation (QA), McGill University (CA), Pakistan Institute of Medical Sciences (PK), Universidad Autónoma de Madrid (ES), Naresuan University (TH), Tehran University of Medical Sciences (IR), Université de Montréal (CA), Niigata University (JP), University of Tübingen (DE), Ludwig-Maximilians-Universität München (DE), University of Lausanne (CH), McMaster University (CA), American University of Beirut (LB)
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Musculoskeletal pain and rehabilitation
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