Women report more pain than men at all 11 body sites in a study of 6.1 million people in 118 countries

Wherever on the body researchers looked, women reported more pain than men. That is the most consistent result of a study published on October 5 in Nature Medicine, which pooled what more than six million people in 118 countries said about their own pain. Across head, face, neck, back, abdomen, hips, knees and four other sites, there was no exception.

The analysis was led by Matt Fillingim and Etienne Vachon-Presseau at McGill University in Montreal, with a large international group of collaborators. Its purpose was broader than the comparison of women and men. Pain is the leading cause of disability worldwide, and the authors set out to chart how common it is at each age and in each region, so that any one country or clinic could see where it stands.

How the study measured pain around the world

Most global figures on pain are built from diagnoses. The Global Burden of Disease project, for example, combines published studies, international surveys and medical claims data and then models the gaps. Diagnoses depend on seeing a doctor, and the McGill team argues that such estimates may leave out people with limited access to health care, which is why they analyzed self-reported pain instead.

They gathered surveys in which people had simply been asked whether they had pain, and where. In all, the team harmonized individual-level self-reported pain data from 6,125,459 participants across 902 population-based data sources in 118 countries. The data were collected from 1990 to 2025 and covered people aged five to more than 100.

Eleven body sites were examined: head, face, neck or shoulder, foot or ankle, hand or wrist, elbow, chest, back, stomach or abdomen, hip and knee. From the pooled answers the researchers drew what they call reference trajectories, curves showing how common each kind of pain is at each age. The idea resembles a growth chart for children, a standard against which a particular group can be compared. The curves have been placed in an open-access benchmarking platform for positioning external datasets against global pain norms.

How much more pain women reported than men

Pain turned up at every site. Prevalence, meaning the share of people affected, ranged from roughly 2% for facial pain to 40% for back pain.

It was consistently higher in women across all 11 anatomical sites. The size of the gap depended on the site, from 8% more common to 83% more common. It was widest for headache, facial and abdominal pain.

Two researchers who were not involved in the study told the Guardian that the result is hard to dismiss. Andrew Horne, who directs reproductive health research at the University of Edinburgh, called it a landmark study. “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,” Horne said.

Rebeccah Slater, professor of pediatric neuroscience at the University of Oxford, pointed to the same mismatch. “The troubling paradox is that women experience more pain, yet their pain is also more likely to be dismissed, diagnosed late or undertreated,” Slater said.

The new study counts pain and does not test why it differs. Earlier work offers partial clues. When Zachary Zimmer and colleagues analyzed surveys from 52 countries in the journal PAIN, women, older persons, and rural residents were all more likely to report pain, with women at about twice the odds. Of the national characteristics they tested, a country’s level of gender inequality explained the most variation in pain between countries. That points toward social conditions without ruling out biology.

On treatment, the evidence is more direct. A team led by Mika Guzikevits at the Hebrew University of Jerusalem examined the records of 21,851 emergency department patients in Israel and the United States who had arrived in pain. Female patients are less likely to be prescribed pain-relief medications compared to males, they reported in the Proceedings of the National Academy of Sciences in 2024, and the disparity held after adjusting for patients’ reported pain scores. In a follow-up experiment, 109 nurses given written case descriptions judged the pain of female patients to be less intense than that of males.

Pain became more common fastest before age 55

Age mattered as much as sex, and its pattern was not the one most people would guess. Pain did grow more common with age, but the climb was steepest early. For men and women, the steepest increase in pain happened before people turned 55, and the share in pain was highest at or beyond 75.

The authors drew a conclusion about working life from that curve. It indicates, they wrote, “that a substantial share of lifetime pain burden develops during working-age adulthood”.

Different pains followed different paths. Headache, abdominal and facial pain peaked earlier in life and then declined. Pain in the neck, shoulder and elbow peaked around midlife. Back, hip and knee pain kept increasing across the lifespan, which the authors link to cumulative wear on the joints that carry the body’s weight.

Severity ran on its own timetable. High-intensity pain peaked at about 50, while generalized pain, felt in many places at once, peaked around 70. In the authors’ words, “the most disabling forms of pain followed an inverted-U trajectory, peaking in mid-to-late adulthood before declining”.

Late-life pain was most common in the least developed countries

The study’s second surprise concerns geography. Existing estimates generally project a higher prevalence of pain conditions in richer regions. The self-reported data pointed the other way.

The researchers sorted countries by the Human Development Index (HDI), a United Nations measure that combines income, schooling and life expectancy. They found that individuals in the lowest HDI countries experienced a substantially higher late-life prevalence of any bodily pain than those in the highest, a difference of about 31 percentage points, with low back pain approaching twice the prevalence at the oldest ages.

Low back pain is already the largest single contributor to disability in the Global Burden of Disease accounts. That project estimated that in 2020, low back pain affected 619 million people globally, with a projection of 843 million by 2050. Its authors also warned that challenges persist in obtaining primary country-level data on low back pain, which is the gap the new reference curves are meant to narrow.

The McGill team tested three risk factors that people or governments can change: smoking, obesity and low income. Together these accounted for 18.3% of the pain burden worldwide. The share 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. In sub-Saharan Africa, in other words, the three measured factors accounted for about an eighth of the pain burden.

What the global pain study cannot show

The authors noted that there were important limitations on the research. Those limitations included different ways of measuring pain, uneven coverage across different regions and oldest and youngest age groups, and the fact that they described patterns for particular age groups, rather than following the same people over time.

Each of those matters. A survey that asks about pain “in the past month” will count more people than one that asks about pain “today”, and harmonizing 902 sources cannot erase every such difference. Because nobody was followed, a 75-year-old in these data is a different person from a 35-year-old, born in a different era, and some of what looks like aging may be a difference between generations.

Self-report has a further complication. Whether someone tells an interviewer about pain depends partly on language and custom. Zimmer’s 52-country analysis found that even after accounting for national characteristics, some variation in pain prevalence remained, which its authors attributed in part to differences in language and interpretations of health. If women in some societies are freer than men to admit to pain, part of the sex gap could lie in the reporting. The gap appeared at every body site in data pooled from 118 countries, which is hard to attribute to reporting habits alone.

What the study changes for pain care

No guideline changes as a result of one descriptive study. What it supplies is a common yardstick. Until now a clinic or a national survey that found 30% of its 60-year-olds in back pain had no age-by-age reference built from people’s own reports to compare the figure with.

The authors see a practical use in the age curves. The distinction between pain that accumulates and pain that intensifies and then resolves, they wrote, “has direct implications for where prevention and care should be concentrated across the lifespan”.

Women reported more pain than men at all 11 body sites in data pooled from 118 countries, which record how often pain is reported and cannot say why.