Pain across the lifespan: global and regional reference curves from 6.1 million individuals in 118 countries

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Abstract
Pain is the leading cause of disability worldwide, yet no population-based reference exists against which individual cohorts, clinical populations, or countries can be benchmarked. Here, we harmonised individual-level self-reported pain data from 6,075,021 participants across 894 population-based data sources in 118 countries to establish global reference trajectories of pain across the lifespan, implemented in an open-access benchmarking platform. Pain prevalence ranged from 2.5% for facial pain to 45.0% for back pain, was consistently higher in women across all eleven anatomical sites (risk ratio range 1.09 to 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 nearly twice the late-life prevalence of any bodily pain compared with those in the highest (risk difference 31.8 percentage points [95% CI 30.1–33.6]). Globally, 18.3% of site-specific pain burden 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 drivers of pain in lower-HDI settings remain poorly characterised.

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