Across six million lives and 118 countries, a 35-year study has confirmed what many women have long sensed but struggled to have heard: their pain is real, patterned, and distinct. Women report higher pain levels than men across every region of the body examined, with the sharpest increases arriving before age 55 — a window that science now suggests is also the most consequential for prevention. The findings ask medicine to reckon with the full architecture of pain: biological, social, and deeply human.
Women under 55 report significantly higher pain levels across all body areas
Pain is recognized as one of the leading causes of disability worldwide, affecting millions across all age groups and geographic regions.
Pain is real and protective, but it doesn't necessarily tell us how much tissue damage is present.
Mark
So this study tracked six million people. That's a real number, right? Not an estimate?
Mimi
Yes—it's drawn from existing health data across 118 countries over 35 years. That's the actual dataset they analyzed.
Luke
But those six million people—are they a representative sample? We don't know who reported their pain or how. Self-reported pain is real, but it's not the same as measured pain.
Mark
Fair point. So what's the headline finding?
Mimi
Women report higher pain across all 11 body areas examined. And the steepest increases happen before age 55 for both sexes.
Luke
Before 55, not after. That's the surprising part. Most people assume pain gets worse as you age.
Mark
Why would that be? Why does pain increase fastest before 55?
Mimi
The researchers point to hormonal factors—estrogen and other sex hormones fluctuate during the menstrual cycle, pregnancy, postpartum, and menopause. That shapes how the nervous system processes pain.
Luke
That's plausible, but it's not proven by this study. The study shows the pattern; it doesn't prove the mechanism.
Mark
What about the modifiable risk factors? Smoking, obesity, low income—those account for 18 percent of pain burden?
Mimi
More than 18 percent globally. But it varies by region. In lower-developed settings, those factors seem to matter more, or at least the pattern is different.
Luke
Which means we don't fully understand what's driving pain in those regions yet. The authors themselves say the underlying factors remain poorly characterized.
Mark
So what's a GP supposed to do with this?
Mimi
Start earlier. Help patients with sleep, movement, nutrition, stress management. Teach them what pain actually is—that it's protective, but it doesn't always mean tissue damage.
Luke
Those are good interventions, but are they proven to prevent pain in younger women? The study doesn't test that.
Mark
It's a framework, then. Not a prescription.
Mimi
Exactly. A framework for thinking differently about who's at risk and when to start paying attention.
O Pulso
- A landmark global study spanning 35 years and six million people has found women consistently bear a heavier pain burden than men across all 11 body areas examined, from headaches to back pain affecting four in ten people.
- The steepest rise in pain for both sexes occurs before age 55, pointing to hormonal and biological factors during midlife that standard care has historically underestimated or ignored.
- Smoking, obesity, and low income together account for more than 18 percent of the global pain burden, and in poorer regions joint and back pain accelerates sharply from age 40 — revealing how economic hardship compounds physical suffering.
- GPs are being called to act earlier, using the pre-55 window to address sleep, stress, physical activity, and pain science education before chronic pain becomes entrenched in patients' lives.
- The emerging framework treats pain not as a purely physical signal but as a complex experience shaped by biology, psychology, and circumstance — one that can be met through multiple, simultaneous pathways of care.
Across six million lives and 118 countries, a 35-year study has confirmed what many women have long sensed but struggled to have heard: their pain is real, patterned, and distinct. Women report higher pain levels than men across every region of the body examined, with the sharpest increases arriving before age 55 — a window that science now suggests is also the most consequential for prevention. The findings ask medicine to reckon with the full architecture of pain: biological, social, and deeply human.
A major international study following six million people across 118 countries over 35 years has found that women report significantly higher pain levels than men across every body area examined — and that the gap grows most sharply before age 55. Pain prevalence ranged from 2 percent for facial pain to 40 percent for back pain, with headaches and abdominal pain tending to peak earlier in life, while back, hip, and knee pain accumulate with age.
Dr. Adele Stewart of the Royal Australian College of General Practitioners sees the findings as a mandate for gender-informed primary care. Hormonal changes across the menstrual cycle, pregnancy, and menopause all shape how the nervous system processes pain — meaning women are not simply experiencing more pain, but experiencing it differently. Standard pain management, she argues, has too often failed to account for these biological realities.
Yet biology is only part of the picture. The study identified smoking, obesity, and low income as modifiable factors behind more than 18 percent of the global pain burden. In lower-income settings, joint and back pain accelerated from age 40 onward, revealing how economic hardship shapes not just whether people hurt, but how quickly that pain compounds. Adverse childhood experiences, Stewart notes, can alter nervous system responses across a lifetime, increasing vulnerability to persistent pain.
The research points toward a clear opportunity: the years before 55, when pain is rising fastest, are also the years most open to intervention. GPs can support patients through sleep, physical activity, nutrition, and stress management as part of routine care. Helping patients understand that pain is real and protective — but not always a direct measure of tissue damage — can itself shift how people relate to their symptoms.
The goal is not to psychologise pain or abandon the search for physical causes, but to adopt a biopsychosocial approach that treats the whole person. For general practice, the message is both urgent and hopeful: there is a window, and it is open.
A sweeping international study tracking pain across six million people in 118 countries over 35 years has found something consistent enough to reshape how doctors think about their younger female patients: women report significantly higher pain levels than men across every body area examined, and the gap widens most sharply before age 55.
The research, which looked at 11 distinct regions of the body, found pain prevalence ranging from as low as 2 percent for facial pain to as high as 40 percent for back pain. But the pattern is not uniform across the body. Headaches and abdominal pain tend to peak earlier in a person's life, while back, hip, and knee pain accumulate with age. What stands out is the trajectory: both men and women experience their steepest increases in pain before they reach 55, a finding that points toward something biological happening during those middle decades.
Dr. Adele Stewart, who chairs the Royal Australian College of General Practitioners' Specific Interests Pain Management group, sees in these numbers a call to action for primary care. The study matters to GPs, she argues, because it underscores why a gender-informed approach to pain is no longer optional—it is foundational. Hormonal fluctuations across the menstrual cycle, pregnancy, postpartum period, and menopause all influence how the nervous system processes pain signals. Women's bodies are not simply experiencing more pain; they are experiencing pain differently, shaped by biological realities that standard pain management often overlooks.
But biology is only part of the story. The research identified three modifiable risk factors responsible for more than 18 percent of the global pain burden: smoking, obesity, and low income. These are not evenly distributed. In lower-developed settings, pain in the joints and back increased more rapidly starting at age 40, suggesting that economic circumstances and access to resources shape not just whether people hurt, but how quickly their pain accumulates. Stewart notes that social and economic hardship influences health behaviors, stress levels, and whether people can access care at all. Adverse childhood experiences, she points out, can alter how the nervous system responds to threat across an entire lifetime, potentially making people more vulnerable to persistent pain without necessarily causing it.
The implication is that prevention cannot wait until pain becomes entrenched. GPs have a window—particularly in those years before 55—to intervene earlier. Stewart describes a broader approach: supporting patients with sleep, physical activity, nutrition, smoking cessation, and weight management as part of routine pain care. Equally important is helping people understand stress and its effects on the nervous system. Chronic stress influences the hormonal, immune, and nervous systems in ways that can amplify and perpetuate pain.
Contemporary pain science education itself becomes a tool. When patients understand that pain is real and protective but does not necessarily reflect the amount of tissue damage present, it can shift how they relate to their symptoms. Mindfulness and other practices that build awareness of bodily sensations and stress responses may help. The goal is not to dismiss pain or reframe it as psychological, but to recognize it as a complex experience shaped by biology, psychology, and social circumstance—and therefore addressable through multiple pathways.
Stewart emphasizes that this is not about assuming past adversity caused someone's pain, nor is it about abandoning the search for physical causes. Rather, it is about adopting what researchers call a biopsychosocial and person-centered approach: treating established pain while also identifying risk earlier, addressing contributing factors, and helping people understand their pain before protective patterns calcify. For GPs, the opportunity is clear. They can begin this work in the office, in those years when pain is rising fastest, before it becomes the defining feature of someone's life.
Citações Notáveis
We need to understand pain as a complex, protective experience influenced by biological, psychological and social factors. This does not make pain any less real; rather, it gives us more ways to help people.— Dr. Adele Stewart, Chair of RACGP Specific Interests Pain Management
We have an opportunity not only to treat established pain, but to identify risk earlier, address contributing factors, and give people a better understanding of their pain before protective patterns become more entrenched.— Dr. Adele Stewart
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