Women report higher levels of pain than men across every major anatomical site, according to a global epidemiological study published in Nature Medicine. Spanning data from 6.1 million individuals across 118 countries between 1990 and 2025, the research highlights a gender pain gap where women suffer more frequently from conditions like headaches, facial pain, and abdominal distress.
The global investigation compiled individual participant data from population-based national, regional, and international health studies conducted between 1990 and 2025. Approved by the McGill University Faculty of Medicine and Health Sciences Research Ethics Board under study number A12-M69-23B (23-10-068), the secondary analysis evaluated deidentified data from 138 study programs. The final analytic dataset included 6,125,459 individuals with valid responses for at least one pain outcome across 118 countries and territories, capturing ages ranging from five years to over 100.
Researchers examined self-reported bodily pain across 11 anatomical locations: the head, face, neck or shoulder, foot or ankle, hand or wrist, elbow, chest, back, stomach or abdomen, hip, and knee. Pain was primarily measured through direct participant self-report using Numerical Rating Scales or Visual Analogue Scales with 0 indicating no pain. Studies relying solely on clinician, observational, or proxy reports were excluded from the analysis.
Global Gender Disparities Across Eleven Bodily Sites
Women reported higher pain prevalence than men across all 11 tracked anatomical sites. This disparity was particularly pronounced in instances of headaches, facial pain, and abdominal discomfort. Researchers described the initiative as one of the largest harmonisation efforts in pain epidemiology to date, drawing on contributions from epidemiologists, clinical pain researchers, population health experts, and individuals with lived experiences of pain.
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, underresearched and undertreated.
Professor Andrew Horne, director of the Centre for Reproductive Health at the University of Edinburgh
Their symptoms face systemic hurdles in clinical settings.
The troubling paradox is that women experience more pain, yet their pain is also more likely to be dismissed, diagnosed late or undertreated.
Professor Rebeccah Slater, a Pediatric Neuroscience expert at the University of Oxford
Pain Prevalence Increases Steepest Before Age 55
Matt Fillingim, PhD, a data scientist and researcher at McGill University who now works for Johnson & Johnson, noted that the global lifespan trajectories show that pain is not a single epidemiological phenomenon but, rather, a set of distinct nonlinear patterns that differ in their timing and anatomical distribution
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The steepest increases in pain prevalence occur prior to age 55, indicating that a substantial share of lifetime pain burden develops during active working-age adulthood. Secondary outcomes tracked in the study included high-intensity pain—defined as an average pain intensity of 7 or higher on a 0–10 scale—and generalized pain, defined as discomfort present in at least four of five body regions. High-intensity pain typically peaks around age 50, whereas generalized pain reaches its zenith near age 70.
Phenotypes varied markedly across age groups. Headaches, abdominal distress, and facial pain peaked earlier in life before declining, a trajectory researchers link to specific hormonal levels.
- Upper body musculoskeletal complaints, including the neck, shoulders, and elbows, peaked around midlife and subsequently declined.
- Lower body pain involving weight-bearing joints like the back, hips, and knees continued to mount across the lifespan due to cumulative mechanical and degenerative load. Approximately 40% of all participants reported experiencing back pain globally, while facial pain emerged as the least common at 2%.
Lower Development Scores Correlate with Higher Pain Prevalence
Individuals residing in regions with lower development scores exhibited a significantly higher prevalence of bodily pain in later life, with low back pain nearly twice as common compared to more developed areas. By age 80 and beyond, overall pain prevalence was roughly 31 percentage points higher in lower-development countries.
Smoking, obesity, and low household income together accounted for 18.3% of the global pain burden.
| Region / Factor | Smoking Contribution | Obesity Contribution | Low Income Contribution |
|---|---|---|---|
| Eastern Europe | 8.5% | 8.6% | |
| Sub-Saharan Africa | 2.5% | 6.6% | |
| Oceania | 6.6% |
Well-established risk factors explained only part of the development-related gap, leaving researchers uncertain about the drivers behind the remaining difference in lower-development settings. Researchers also noted limitations, including a cross-sectional design that relied on single-point observations rather than tracking the same individuals over time, leaving the cause of the remaining difference in lower-development settings unresolved.