Pain peaks in women under 55 — what a 35-year global study found

Pain was high on the list of things medicine got wrong about women for a long time.

Not necessarily because individual clinicians were callous — though dismissal happened — but because the population-level data to contradict common assumptions didn’t exist at the scale needed to make the case plainly. A GP working from the evidence base of 2005 might reasonably conclude that the sex difference in pain was modest or inconsistent. That position is now much harder to sustain.

A large-scale analysis published this week in Nature Medicine draws on over six million people across 118 countries and 35 years, covering 11 anatomical sites including back, knee, hip, shoulder, neck, abdomen, and head. The finding that cuts across every site: women report more pain than men, consistently, across virtually every country and decade studied. As RACGP newsGP reports, both sexes see their fastest increase in pain before age 55, with back, hip, and knee pain rising progressively with age while headaches and abdominal pain peak earlier in life.

For anyone under 55 who has been told their pain is disproportionate, psychosomatic, or unlikely to have a physical explanation — this dataset is meaningful context.

What the scale of this study changes

The headline numbers: pain prevalence ranges from about 2% for facial pain to roughly 40% for back pain across the global sample. Smoking, obesity, and low income together account for over 18% of the global pain burden — modifiable contributors that general practice is positioned to address. In lower-resource settings, joint and back pain rise more steeply from around age 40, suggesting access to management matters as much as biology.

What makes this study useful clinically is not novelty — the observation that women report more pain has appeared in smaller studies — but the consistency across 118 countries and three-and-a-half decades. Cross-site, cross-country consistency at that scale is difficult to explain as a methodological artefact or a cultural reporting effect. It points toward biological mechanisms that operate across diverse populations.

Dr Adele Stewart, Chair of RACGP Specific Interests Pain Management, comments via newsGP that hormonal changes across the menstrual cycle, pregnancy, the postpartum period, and perimenopause may influence pain sensitivity and processing. This is not the “it’s hormonal” dismissal many women have encountered. It is the recognition that the neurobiological systems modulating pain are responsive to hormonal context — a distinction that should inform investigation rather than close it off.

Both-and: what this validates and what it doesn’t simplify

This research validates a pattern many women — and many of their GPs — have observed across decades of clinical encounters. It makes a population-level case for taking pain seriously, for investigating it thoroughly, and for not defaulting to the assumption that the absence of visible structural damage means the absence of a real clinical problem.

And: the right framework for managing pain in 2026 is not a purely biomedical hunt for damage, for anyone. Dr Stewart’s commentary is careful on this point: pain is a protective experience shaped by biological, psychological, and social factors. That framing does not make pain imaginary — it makes it complex, and it opens more treatment pathways than a structural-only model.

A genuinely biopsychosocial approach to pain includes addressing modifiable contributors: sleep quality, physical activity, nutritional adequacy, smoking, and body weight. It includes trauma-informed care, because the literature on adverse childhood experiences and vulnerability to persistent pain is well-established. It includes pain science education — helping people understand the relationship between pain signals and tissue damage without dismissing either — and, where appropriate, formal pain management programmes that combine physiotherapy, psychology, and medical review.

What it does not mean is telling a person with real pain that their problem is psychological and offering no further pathway. That remains a clinical failure, and the scale of this dataset makes the case against it more clearly than before.

2 cents

If you are a woman under 55 with pain that has been dismissed, inadequately investigated, or attributed to anxiety without further follow-up, this research is context for a GP conversation. The question worth asking at your next appointment is not “why am I in pain” in the abstract, but specifically: what has been investigated, what hasn’t, and what is the plan if current management isn’t working.

For GPs: the data supports more proactive pain assessment in women presenting in their 30s, 40s, and early 50s, before patterns become entrenched. Earlier access to allied health — physiotherapy, psychology, pain education programmes — and honest conversations about the biopsychosocial picture are the practical translations.

Verdict: yes — a large, robust study that confirms a clinically important pattern with direct implications for how women’s pain is assessed and managed in general practice.

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Sources cited

1. Pain more common in women under 55 — RACGP newsGP
2. Global pain prevalence, 1990–2025 — Nature Medicine