A recent study analyzing self-reported pain data from 6,125,459 participants across 118 countries confirms that women consistently experience more pain than men.
The findings — which appear in Nature Medicine — indicate that women consistently report experiencing more pain across no fewer than 11 anatomical sites.
These are the head, face, neck and shoulder area, hand and wrist area, elbows, foot and ankle sites, the knees, the chest, the back, abdominal area, and the hips. The highest prevalence was for back pain, at 40%.
First author Matt Fillingim, PhD, a postdoctoral researcher at McGill University in Montreal, Canada, told Medical News Today that, while the exact reasons why women experience more pain remain unclear, they are likely to be related to a combination of different factors.
“There likely isn’t one single explanation,” said Fillingim. According to him:
“The difference probably reflects a combination of biological and social factors, including sex hormones, immune function, nervous-system pain processing, stress, reproductive burdens, occupational exposures, healthcare use, and differences in how symptoms are reported.”
He also cited studies in animal models that appear to suggest “genuine sex differences in pain mechanisms.”
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Specifically, he referenced studies from McGill professor Jeffrey Mogil, PhD, FCAHS, FRSC, “showing in animal models that males and females can recruit different immune pathways in pain hypersensitivity.”
“What stood out in our [recent] study is that the difference [of reported pain between sexes] was present across all 11 body sites, though the size of the gap varied considerably by pain type, which again suggests there is unlikely to be one universal mechanism,” Fillingim pointed out.
Shuchita Garg, MD, an associate professor of clinical medicine in the Department of Anesthesia/Division of Chronic Pain, and the medical director of the University of Cincinnati Medical Center Pain Clinic, who was not involved in this study, commented on the findings for MNT.
“This study is a major contribution to the field and challenges some of the existing data,” Garg told us. However, she also offered a word of caution regarding the interpretation of the methodology.
“Since most of the data are cross-sectional, they show the age patterns within populations rather than the changes that take place in individuals,” she explained. “Moreover, the estimates refer to point or period prevalence and not to chronicity, meaning that this study deals generally with pain and not just with chronic pain.”
Since the recent study highlights the consistently higher prevalence of pain in women, it also raises the question as to why.
According to Garg, “the reasons why women have a higher prevalence of pain are complicated and include biological, hormonal, and psychosocial elements, the greatest differences being found in the case of facial and abdominal pain, headaches as well as in instances of severe symptoms.”
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“The differences are greatest in the case of migraine, temporomandibular, and visceral pain — conditions which correspond with the reproductive years. It is believed that pubertal development and sex hormones cause the difference between adolescent boys and girls,” she explained.
Garg also highlighted differences in immune pathways, noting that neuropathic pain has been linked to the activity of specialized immune cells called microglia in males, and T-cell — a type of white blood cell — activity in females. However, she also stressed that these findings are currently based largely on preclinical research in rodent models.
“Conditions that differ by sex — such as dysmenorrhea, endometriosis, and pelvic pain — contribute directly to the size of the abdominal area,” she explained. “The pain in question is nociplastic [a form of dull, deep, persistent pain], and the type of pain amplification seen in fibromyalgia is more frequently observed in women, which is consistent with the severity and the extent of the pain.”
Finally, “the role of psychosocial factors and access to care includes the possibility that higher rates of depression, anxiety, trauma exposure, caregiving burden, and delays in diagnosis and treatment may be involved,” Garg hypothesized.
The recent Nature Medicine study also found that, across sexes, the most rapid increases in musculoskeletal pain occurred earlier in life, between the ages of 20 and 55 years, to be precise, though the most pain tended to be reported around or after the age of 75.
Pain across all the studied anatomical sites, across genders, increased in prevalence most rapidly before the age of 55.
“Importantly, this does not mean pain is highest before age 55,” stressed Fillingim. “Rather, it means that across much of the body, the proportion of the population reporting pain is increasing most rapidly during this period,” he clarified.
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“For some conditions, such as back, hip, and knee pain, prevalence continues to rise well into older age,” the researcher added.
While, once again, he noted that the exact reason why the most rapid increases in pain occur before the age of 55 remains unclear, “one explanation is that early and middle adulthood are when many exposures that contribute to pain begin to accumulate,” he suggested.
This includes “physical workload, injuries, weight gain, metabolic disease, stress, and repetitive strain.” He also noted that, “by older age, a substantial portion of that burden may already be established.”
Speaking to MNT, Vernon Williams, MD, a sports neurologist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Orthopedics and Sports Medicine in Los Angeles and B-ASE Performance, Inc, also emphasized that age may not be the only factor responsible for the increase in pain prevalence.
Williams, who was not involved in the recent study, likewise explained that an accumulation of different factors is likely to explain this increase before age 55:
“By midlife, people may have accumulated injuries, repetitive strain, changes in physical activity, stress, sleep disruption, and other factors that can influence how the nervous system processes pain. Pain is a complex experience, and the brain’s response can become more sensitive over time. So, the increase we see before 55 may reflect the cumulative effects of these biological, psychological, and social factors rather than a single age-related cause.”
Following from this, Garg suggested that “efforts to prevent pain should be directed at adults in their 20s and 40s, and pain management must be tailored to the individual — this should begin with a thorough investigation for possible treatable causes, promote physical activity, take into account psychological therapies, and look at modifying risk factors.”
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“In practice, the most effective way of supporting people who have pain is through a multifaceted approach,” she advised.
“I hope the findings encourage a more lifespan-based approach to pain prevention and surveillance,” Fillingim told MNT, reflecting on the desired impact of his and his colleagues’ study. “The fact that many pain trajectories change most rapidly before later life suggests there may be important windows for earlier prevention or intervention.”
At the same time, he emphasized that important chunks of data are still missing at the global level, and that much more information is needed in order to complete the picture.
“I also hope the work brings more attention to major gaps in global pain data,” he said, noting: “We had tremendous difficulty identifying and accessing suitable datasets from lower-HDI [Human Development Index] regions, particularly parts of sub-Saharan Africa, Southeast Asia, and other underrepresented regions.”
According to Fillingim, “this reflects several challenges, including limited existing data collection, fewer large cohort studies, resource constraints for data storage and maintenance, limited research infrastructure, and difficulties making data available for secondary analysis.”
“One of the clearest goals from this work is to motivate greater investment in collecting and maintaining high-quality pain data in these regions. Without those data, it is much harder to understand why pain burden is so high at certain ages, how it changes across the lifespan, and which prevention or treatment strategies are most appropriate.”
— Matt Fillingim, PhD
Addressing people experiencing life-quality-altering pain, Williams said: “My first advice is not to simply try to ‘live with’ chronic pain or mask it with medication.”
Instead, he advised, “get[ting] a thorough evaluation to understand what may be contributing to the pain, because the most effective treatment depends on identifying the type and source of pain.”
“From there, focus on restoring function and movement, while considering a comprehensive approach that may include physical therapy, exercise, behavioral strategies, mindfulness, and medication when appropriate. Chronic pain is complex, but it does not necessarily have to be permanent,” said Williams.
Garg also emphasized that “exercise helps to reduce pain, improve functioning and enhance general health,” noting that “there is no one type that is better than the others” as long as it is a consistent habit.
“Exercise programs, cognitive behavioral therapy (CBT) and acceptance and commitment therapy should be emphasized as treatments for chronic musculoskeletal pain; these forms of therapy affect the way pain is processed in the nervous system and must not be misunderstood as suggesting that the pain is imagined.”
— Shuchita Garg, MD
“Modifiable factors such as sleep, smoking, weight loss, and mood are important factors that could impact the intensity and quality of pain, hence due attention to treatment of these need to be addressed,” she added.
Finally, “it is better to focus on functional goals, such as improving mobility, quality of life and activities of daily living or getting back to work than it is to aim at eliminating all pain,” Garg concluded.
