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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BibTeX
@article{fillingim2026global,
title = {{Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries}},
author = {Matt Fillingim and Christophe Tanguay-Sabourin and Lindsay Neuert and Azin Zare and Jax Norman and Gianluca Guglietti and Lise Hobeika and Abimbola Ayorinde and Ahmad Salimzadeh and Ahmad-Reza Jamshidi and Aqeel Alenazi and Arash Tehrani-Banihashemi and Bader Alqahtani and Beatriz Olaya and Benjamin Longo Mbenza and Bibilola Oladeji and Brenda Penninx and Buddhi Paudyal and Caique de Melo and Chantal Berna and Clarissa Humberg and Pascal Claudepierre and Elisa Smith and Elizabeth Vandenkerkhof and Erik Giltay and Esther Garcia-Esquinas and Faisal Parlindungan and Fatima Qayyum Abbasi and Fernando Rodríguez Artalejo and Gareth Jones and Gary Slade and Hanifa Bouziri and Herta Flor and Hiroyasu Iso and Ian Gilron and Imad Uthman and Ingris Peláez-Ballestas and Jean-Paul Divengi Nzambi and Jose Luis Ayuso-Mateos and Josep Maria Haro and Julia Wager and Juliana Barcellos de Souza and Kazutoshi Nakamura and Keiko Yamada and Lisa-Marie Rau and Makram Talih and Marcus Beasley and María Dueñas and Marie Zins and Marta Miret and Melissa Wake and Mirza Zaka Pratama and Mohammed Almalki and Monique Chaaya and Muhammad Anshory and Naoki Kondo and Navid Moghadam and Norma Mansor and Omar Alsaed and Orawan Keeratisiroj},
journal = {Nature Medicine},
year = {2026},
month = oct,
doi = {10.1038/s41591-026-04696-w},
url = {https://hal.science/hal-05839168v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries
AU - Matt Fillingim
AU - Christophe Tanguay-Sabourin
AU - Lindsay Neuert
AU - Azin Zare
AU - Jax Norman
AU - Gianluca Guglietti
AU - Lise Hobeika
AU - Abimbola Ayorinde
AU - Ahmad Salimzadeh
AU - Ahmad-Reza Jamshidi
AU - Aqeel Alenazi
AU - Arash Tehrani-Banihashemi
AU - Bader Alqahtani
AU - Beatriz Olaya
AU - Benjamin Longo Mbenza
AU - Bibilola Oladeji
AU - Brenda Penninx
AU - Buddhi Paudyal
AU - Caique de Melo
AU - Chantal Berna
AU - Clarissa Humberg
AU - Pascal Claudepierre
AU - Elisa Smith
AU - Elizabeth Vandenkerkhof
AU - Erik Giltay
AU - Esther Garcia-Esquinas
AU - Faisal Parlindungan
AU - Fatima Qayyum Abbasi
AU - Fernando Rodríguez Artalejo
AU - Gareth Jones
AU - Gary Slade
AU - Hanifa Bouziri
AU - Herta Flor
AU - Hiroyasu Iso
AU - Ian Gilron
AU - Imad Uthman
AU - Ingris Peláez-Ballestas
AU - Jean-Paul Divengi Nzambi
AU - Jose Luis Ayuso-Mateos
AU - Josep Maria Haro
AU - Julia Wager
AU - Juliana Barcellos de Souza
AU - Kazutoshi Nakamura
AU - Keiko Yamada
AU - Lisa-Marie Rau
AU - Makram Talih
AU - Marcus Beasley
AU - María Dueñas
AU - Marie Zins
AU - Marta Miret
AU - Melissa Wake
AU - Mirza Zaka Pratama
AU - Mohammed Almalki
AU - Monique Chaaya
AU - Muhammad Anshory
AU - Naoki Kondo
AU - Navid Moghadam
AU - Norma Mansor
AU - Omar Alsaed
AU - Orawan Keeratisiroj
PY - 2026
DA - 2026/10/05
JO - Nature Medicine
DO - 10.1038/s41591-026-04696-w
UR - https://hal.science/hal-05839168v1
AB - 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.
SN - 1078-8956
SN - 1744-7933
ER -