What is pain?

Pain is one of the most common human experiences. According to the International Association for the Study of Pain (IASP) pain can be seen as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”¹ This definition emphasises that pain can exist with or without physical injuries.

One non-physical aspect that has been found to be strongly linked to pain is people’s demographic characteristics. For example, prior work has shown that people with lower levels of education tend to report more pain than those with higher levels of education². However, most of this evidence comes from studies that focused on specific countries and cross-cultural differences remain largely unexplored.

Pain is also a subjective experience: the most reliable way to know if someone is in pain is simply to ask them. While objective biomarkers that might signal pain do exist (e.g., inflammation markers), individual differences in pain tolerance highlight the importance of self-reported pain in any evaluation.

In this study, we asked people about their bodily pain and explored whether and how pain differed across 22 countries and key demographic groups including age and gender groups, marital status, level of education, and employment status.

The Global Flourishing Study

 We used data from the Global Flourishing Study (GFS)³ which involves large-scale representative data from 202,898 participants from 22 geographically and culturally diverse countries: Argentina, Australia, Brazil, Egypt, Germany, Hong Kong, India, Indonesia, Israel, Japan, Kenya, Mexico, Nigeria, the Philippines, Poland, South Africa, Spain, Sweden, Tanzania, Turkey, the United Kingdom, and the United States. The data were collected by Gallup Inc. in 2022 and 2023.

The GFS is a rich dataset that includes not only a wide range of countries but also a broad set of variables related to wellbeing, including happiness, life satisfaction, meaning in life, character, relationships, health, and financial stability. Four additional waves of data will be collected annually from 2024-2027. This will result in a longitudinal dataset with five waves across 22 countries, enabling the exploration of causal relationships among key aspects of people’s wellbeing.

In each country, people were asked “How much bodily pain have you had during the past 4 weeks?” Respondents could answer a lot, some, not very much, or none at all. In our main analyses, this variable was dichotomised as A lot/Some (1) vs. Not very much/None at all (0). This approach allowed us to estimate the proportion of people in pain in each country.

We applied rigorous statistical methods, including random-effects meta-analysis. This approach accounts for both within- and between-country variability: it first conducts individual analyses in each country and then pools the country-specific results to summarise patterns across the 22 countries.

Key findings

Our first set of findings showed that pain varied substantially across countries. For instance, Egypt (0.60), Brazil (0.59), Australia (0.56), and Turkey (0.53) were at the top of the ranking of the proportion of people in pain whereas Israel (0.25), South Africa (0.29), Poland (0.32), and Japan (0.33) were at the bottom showing the lowest proportion of people in pain.

These cross-country differences can be motivated by country-specific aspects like life expectancy, access to healthcare, and macroeconomic conditions. The interpretation of our pain variable can also influence these findings. For instance, the question asks about “bodily pain” which might have different meaning to different people.

Our second set of results came from the random effects meta-analysis and revealed that, across the 22 countries, the proportion of people in pain was greatest in older age groups, among women and other gender groups, the widowed, those who were retired, and those who had low level of education.

The age-related findings are worth highlighting. In our pooled analyses of the 22 countries, we found the highest proportion of people in pain among older age groups. However, some countries showed different patterns. For instance, Australia, Brazil, Egypt, and the United States showed high proportions of people in pain in middle-age groups. This aligns with previous research showing a rapid increase in the percentage of people in pain during middle age⁴, suggesting that the age-pain link might be country-specific.

One limitation of this study is that the wording of the pain question did not allow us to explore the type of pain, for example, whether bodily pain was chronic or acute. Another limitation is that our data did not allow us to explore causal relationships because all variables were collected at the same time. This issue will be addressed in the subsequent waves of the GFS that will provide data from the same participants over five years.

Why this matters

By showing that pain varies across key demographic groups and across 22 countries worldwide, our study serves as a starting point for future research on other non-physical aspects of pain.

The cross-country variation highlights the need for further work on the cross-cultural aspects and country-specific conditions that might shape citizens’ level of pain.

Overall, these findings highlight the importance of pain variation and encourage researchers to explore both the mechanisms and reasons behind these differences. We hope that future waves of the GFS will help advance the science in this area and contribute to improving both individual and national wellbeing.

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References

1. Raja, S. et al. The revised IASP definition of pain: concepts, challenges, and compromises. Pain 161, 1976–1982 (2020).
2. Case, A., Deaton, A. & Stone, A. A. Decoding the mystery of American pain reveals a warning for the future. Proceedings of the National Academy of Sciences of the United States of America 117, 24785–24789 (2020).
3. Johnson, B. R. et al. The Global Flourishing Study. (2024). Available at: https://doi.org/10.17605/OSF.IO/3JTZ8.
4. Macchia, L. Pain trends and pain growth disparities, 2009–2021. Economics and Human Biology 47, 101200 (2022).