Prevalence of chronic pain in the general population: A systematic review and meta-analysis

Ashok Kumar Saxena; Neha Singh; Geetanjali T. Chilkoti; Michell Gulabani; Rajeev Kumar Malhotra

doi:10.25259/IJMR_1935_2025

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Review Article

163 (

); 355-370

doi:

10.25259/IJMR_1935_2025

Prevalence of chronic pain in the general population: A systematic review and meta-analysis

Ashok Kumar Saxena¹, Neha Singh¹, Geetanjali T. Chilkoti^1,, Michell Gulabani¹, Rajeev Kumar Malhotra²

1Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

2Department of Biostatistics, All India Institute of Medical Sciences, Delhi, India

For correspondence: Prof Geetanjali T Chilkoti, Department of Anaesthesia, University College of Medical Sciences, New Delhi 110 062, India e-mail: geetanjalidr@yahoo.co.in

Received: 2025-07-23, Accepted: 2025-12-24, Published: 2026-04-04

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Saxena AK, Singh N, Chilkoti GT, Gulabani M, Malhotra RK. Prevalence of chronic pain in the general population: A systematic review and meta-analysis. Indian J Med Res. 2026;163:355-70. doi: 10.25259/IJMR_1935_2025.

Abstract

Background and objectives

Chronic pain represents a significant health concern affecting a large segment of society. To date, no systematic review and meta-analysis has evaluated the prevalence of chronic pain in the general population aged 18 to 95 years. The present study aimed to assess prevalence of chronic pain in this age group and examine its variation across age, sex, geographical regions, and psychosocial factors.

Methods

Cochrane Library, PubMed, and MEDLINE, were searched by combining combination of two categories of keywords (prevalence, chronic pain, epidemiology, population-based study, meta-analysis) in the general population till May 2024.

Results

A total of 52 studies with 2,89,490 participants were included to ascertain the global prevalence of six types of chronic pain: non-specific chronic pain, fibromyalgia, chronic lower back pain, chronic back pain, chronic widespread pain, and chronic musculoskeletal pain. The overall pooled random-effect prevalence percentage of chronic pain was 26.99%. The chronic pain prevalence percentage was significantly higher in those above 45 yr of age (46.7%), compared to 24.2% in those between 18-45 yr (P<0.001). The prevalence of chronic pain was higher in women as compared to men (31.42% vs. 21.63%) (P=0.07).

Interpretation and conclusions

The present global meta-analysis of chronic pain across the age group of 18–95 yr, observed a higher prevalence in women and in those alone 45 years of age. There was no geographical difference.

Keywords

Chronic pain

Fibromyalgia

Meta-analysis

Migraine

Prevalence

Systematic review

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Chronic pain is a significant healthcare problem with ramifications impacting the social, economic, and health ecosystem worldwide. The International Association for the Study of Pain (IASP) defines chronic pain as pain that lacks an apparent biological purpose and persists beyond the normal period of tissue healing, typically exceeding three months.¹ It may be considered a disease as described by the European Federation of IASP chapter on declaration of pain.² The reported prevalence of chronic pain worldwide ranges from 30% to 40% as cited in various studies.^3,4 Chronic pain can be of different types e.g., lower back pain, cervical spine pain, anterior chest pain, chronic widespread pain, fibromyalgia syndrome, migraine, neck pain, and neuropathic pain.^5-7

The literature is replete with studies reporting the incidence of chronic pain in Western countries. The chronic pain prevalence was 26.8% in a study on the German population⁸ and 3.6% in the United States of America.⁹ Bannwarth et al¹⁰ and Branco et al¹¹ conducted studies in the European population and reported a prevalence of 10%, 10%, 11%, 13%, and 23% in France, Italy, Germany, Portugal, and Spain, respectively.

In the Indian subcontinent, Dureja et al¹² described the overall chronic pain prevalence as 13%. Various meta-analysis available in the literature, among different age groups across the globe, highlight chronic pain as a significant health concern.^13-15 Chronic pain is especially prevalent (upto 66%) in populations, on palliative care treatment.¹⁶

Efficacious pain relief is therefore a cornerstone of palliative care, aiming to alleviate agony and enhance the quality of life for patients with life-limiting illnesses. Chronic pain not only physically and mentally drains affected persons, but also negatively impacts the economy and productivity of the nation at large. In a recent Norwegian study, it was found that chronic pain imposes a significant financial burden, to the extent of 4% of gross domestic product, emphasising the importance of patient education and improved rehabilitation of those suffering.¹⁷

Accordingly, the present study aimed to conduct a systematic review and meta-analysis of the available literature to estimate the prevalence of chronic pain and to examine its variation across age, gender, geographical regions, and psychosocial factors among different age groups, with the ultimate goal of informing health policy planning and implementation.

Methods

The study was carried out in compliance with the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.¹⁸ Subsequently, it was registered in the PROSPERO registry with no. CRD 42023439427.

Search strategy

The literature search was conducted till May 2024 which included searches on online databases such as PubMed, MEDLINE, Cochrane Library, Google Scholar, Science Direct, Embase, ProQuest, Scopus, CINAHL, and AMED. The details of search strategy are presented in Supplementary Table I.

Supplementary Table I

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Inclusion and exclusion criteria

All population-based studies involving adults (cross-sectional studies, cohort studies, and national reports) published up to May 2024 and reporting on the prevalence of chronic pain in the general population aged 18–95 years were included. All eligible criteria were selected for further review and synthesis. Studies published in only English language were included. Narrative and systematic reviews, case reports, qualitative studies, editorials, conference proceedings, opinion papers, and letters) were excluded.

Screening and Selection of relevant studies

Screening was performed in two stages: an initial review of titles and abstracts, followed by full-text retrieval and assessment based on predefined inclusion and exclusion criteria. Two pairs of reviewers (NS, GTC) separately screened each record’s titles and abstracts. The studies that were unclear or controversial were advanced to full-text screening. Any disagreements arising during full-text screening were resolved through consensus in consultation with the lead researcher (AKS).

Data extraction and management

The extracted data included final full-text manuscripts, which were collected in a format containing research information, characteristics of the participants included in the study, and outcome measures.

Outcome measures

The primary outcome was to estimate the prevalence of chronic pain in the general population based on the pooled findings of the included studies. The secondary outcomes were to find the differences in the prevalence of chronic pain based on age, sex, race/ethnicity, geographic location, socioeconomic status, and other demographic or clinical factors.

Quality assessment

To assess the potential risk of bias, we applied the risk of bias tool developed by Hoy et al.¹⁹ To evaluate the risk of bias, two reviewers assessed and rated each of the 10 items mentioned into two dichotomous ratings: low or high risk. ‘Low risk’ indicated that further research was very unlikely to change the confidence of the estimates, whereas ‘high risk’ indicated that further research was very likely to change the estimate. Cohen Kappa was used to assess the strength of agreement between the two independent assessors.

Qualitative assessment

The reporting quality of the included articles was evaluated in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.²⁰ The methodological quality related to chronic pain assessment was evaluated across five domains: characteristics of the study population, adequacy of sample size, participation rate, outcome measurement, and analytical approach. Each domain was scored from 0 to 2, and the sum of these scores reflected the overall study quality. The modules having ‘low risk’ assigned were 2, ‘moderate risk’ 1, and ‘high risk’ 0. The maximum score of the assessment was 10. The study was considered ‘low risk’ when the total score was greater than 8, moderate if it was 7 or 8, and high-risk when it was less than or equal to 6.

Statistical analysis

A meta-analysis of proportions was performed using R software (version 4.1.0; R Foundation for Statistical Computing). Statistical significance was set at an α level of 0.05. Given the expected substantial heterogeneity, pooled prevalence estimates were calculated using the meta::metaprop function, applying a random-effects model with restricted maximum-likelihood estimation. Proportions were defined as the number of individuals with chronic pain relative to the total sample size. To stabilise variance, individual study proportions were transformed using the Freeman–Tukey double arcsine method. Clopper–Pearson 95% confidence intervals (CIs) were derived for individual studies, while Wald 95% CIs were used for the pooled estimates. Forest plots corresponding to each primary outcome were generated using the meta::forest function.

Between-study heterogeneity was assessed using the I² statistic. Threshold values of 30%, 50%, and 75% were used to indicate moderate, substantial, and considerable heterogeneity, respectively, in line with recommendations from the GRADE framework (Grading of Recommendations, Assessment, Development, and Evaluations) and guidance provided in the Cochrane Handbook for the interpretation of heterogeneity.^21,22

The tests of heterogeneity was performed to determine the extent of variation between the selected studies. The Q-statistic was employed to test the null hypothesis that all studies share a common effect size. The Egger regression intercept test and the Begg and Mazumdar rank correlation test, as well as visual inspection of funnel plots for asymmetry, were used to assess bias in publication via the meta::metabias and meta::funnel functions, respectively.

Results

Literature search

This PRISMA flow diagram is shown in Figure 1. The summary of the studies included is shown in Table I.^1,6,12,23-71

PRISMA flow diagram. PRISMA, preferred reporting items for systematic reviews and meta-analysis.

Table I. Summary of the studies included in this current Systematic review and meta-analysis

S. No.	Study	Sample size (N)			Age group	Population type	Sampling year and survey method	Pain type	Geographical region	Sampling area	Definition of chronic pain	Prevalence (%)			95% CI (%)
		T	F	M								T	F	M
1	Saxena et al¹, 2018	4326	2345	1981	18-80	General	2006Q	Nonspecific chronic pain	India	N	IASP definition of CP (pain lasting >=3 months)	19.3	25.2	12.3	18.13-20.50
2	Bouhassira et al⁶, 2008	23712	12330	11382	>=18	General	2004Q	Nonspecific chronic pain	France	N	Daily pain lasting >=3 months; score of >=3 on DN4 interview questionnaire to identify neuropathic pain characteristics	31.7	35	28.2	31.11-32.30
3	Dureja et al¹², 2013	5004	48%	52%	>=30	General	2001AND2011I	Nonspecific chronic pain	India	N	Persistent continuously or intermittently pain for 3months or more in past 6months	13	NR	NR	12.10-13.98
4	Kossi et al²³, 2022	4320	1756	2563	>= 18	General	2021I	CLBP	Benin (Western Africa)	R/L	Pain between the 12th riband the gluteal cleft, with or without radiation to the legs, lasting at least 12weeks without a specific underlying pathology or occurring episodically within 6 months	35.5	34.7	36	34.08-36.96
5	Ai et al²⁴, 2023	15423	7917	7506	>=45	General	2018I	Nonspecific chronic pain	China	N	Pain lasting for more than 3 months	60.02	58.3	41.7	59.24-60.80
6	Li et al²⁵, 2021	1381	764	617	>=60	General	2018-2019 I	Nonspecific chronic pain	China	N	Pain lasting >=3 months was defined as a chronic pain following the IASP classification	57.3	57.1	42.9	54.62-59.91
7	Gaya et al²⁶, 2020	4916	NR	NR	>=20	General	2016I	FM	Spain	N	Diffuse chronic pain more than 3months (ACR criteria for the classification of FM was published in 2010)	2.45	4.49	0.29	2.04-2.92
8	Wong et al²⁷, 2011	5001	NR	NR	>=18	General	2007I	Nonspecific chronic pain	Hong King	N	Pain persisting for at least 3 months	34.9	40	29	33.57-36.23
9	Liberman et al²⁸, 2018	419	NR	NR	>=65	General	NRI	Nonspecific chronic pain	Israel	R/L	Pain persisting for at least 3 months	55.2	NR	NR	50.23-59.94
10	Sharon et al²⁹, 2022	1647	914	733	>=18	General	2017Q	Nonspecific chronic pain	Israel	N	Any kind of chronic pain that is constant or recurrent, for 3 months or longer	31.3	33.6	28.2	29.10-33.64
11	Torrence et al³⁰, 2006	3002	1669	1333	>=18	General	NRQ	Nonspecific chronic pain	UK	N	Pain lasting for more than 3 months	48	NR	NR	46.20-49.81
12	Dablhamer et al³¹, 2018	33028	NR	NR	>=18	General	2016Q	Nonspecific chronic pain	US	N	Pain on most of days or every day in the past 6months	20.4	22.1	18.6	19.94-20.82
13	Giorno et al³², 2017	1293	739	544	>=18	General	2014Q	Nonspecific chronic pain	Narni, Umbria (Italy)	R/L	Pain lasting for at least 3 months	28.4	34.1	21	25.93-30.92
14	Stompore et al³³, 2019	145	110	35	>=60	General	NRQ	Nonspecific chronic pain	Poland	N	Presence and location of chronic pain (lasting longer than 3 months)	78	NR	NR	70.14-84.20
15	Iizuka et al³⁴, 2017	213	138	75	>=50	General	2013Q	CLBP	Japan	N	Pain continuing for >=3 months	15.4	16.6	13.3	11.09-21.20
16	Ge et al³⁵, 2022	1941	1082	859	21-97	General	2015-2017I	CLBP	Singapore	N	Pain lasting for more than 3 months	8.1	10.25	8	6.89-9.37
17	Antunes et al³⁶2021	8445	NR	NR	>=18	General	2017-2018I	Nonspecific chronic pain	Portugal	N	Individuals who (1) had pain for more than 3 months, (2) had pain for less than 3 months, but the pain persisted after the cause was healed, or (3) had a previous diagnosis of CP but were asymptomatic due to suitable treatment	33.6	NR	NR	32.59-34.62
18	Neville et al³⁷, 2008	3738	1995	1743	>=25	General	NRQ	Nonspecific chronic pain	Israel	R/L	Any pain or discomfort that persists continuously or intermittently for longer than 3 months, in the last 6 months	46	52.2	38.9	44.41-47.63
19	Duenas et al³⁸, 2025	4690	2138	2552	18-85	General	2022I	Nonspecific chronic pain	Spain	N	Pain persisting for at least 3 months	25	58.7	41.3	23.76-26.26
20	Inoue et al³⁹, 2016	5437	2992	2445	>= 20	General	2013Q	Nonspecific chronic pain	Japan	N	1) Pain lasting >= 6 months (excluding toothache, migraine, and menstrual pain); (2) Pain experienced over the past month and at least twice over the past week and (3) pain intensity >= 5 on a 10-point NRS during the most recent episode of pain	16.6	17.9	15.09	15.61-17.61
21	Santose et al⁴⁰, 2015	1656	1058	598	>= 60	General	2009-2010I	Nonspecific chronic pain	Santa catorina(SouthAmerica)	R/L	Pain lasted for 6 months or more as established by IASP	29.3	37	17.7	27.11-31.55
22	Husky et al⁴¹, 2018	17249	NR	NR	18-98	General	2005 I	CBP	France	N	Pain persisting for more than 3 months	38.3	41.3	34.3	37.57-39.02
23	Yamada et al⁴², 2022	12883	6196	6687	>= 65	General	2019Q	ChronicMusculo-skeletal	Japan	N	Pain in designated musculoskeletal sites (neck, shoulder, elbow, wrist, finger, back, hip, knee, ankle and toe)lasting >= 3 months	39	41.8	36.3	38.15-39.84
24	Metwally et al⁴³, 2019	1031	644	387	>= 18	General	2016Q	Nonspecific chronic pain	Arabia	R/L	Any self-reported pain lasting for 3 months or more	19	18.3	20.6	16.67-21.55
25	Toth et al⁴⁴, 2009	1207	NR	NR	>= 18	General	NRI	Nonspecific chronic pain	Alberta (Canada)	R/L	Pain duration >= 3 months	35	NR	NR	32.24-37.71
26	Aili et al⁴⁵, 2021	1858	1027	831	20-74	General	1995-2016Q	Chronic musculoskeletal pain	Scandinavia(Sweden)	R/L	Persistent or recurrent pain lasting > 3 months present on both sides of the body, below and above the waist, and in the axial skeleton using pain mannequin	6.4	8.5	3.7	5.33-7.61
27	Azevedo et al⁴⁶, 2012	5094	3304	1790	>= 18	General	2007-2008 I	Non-specific chronic pain	Portugal	R/L	Pain lasting >= 3 months	36.7	45.7	27	35.36-38.03
28	Jakobsson et al⁴⁷, 2010	826	485	341	18-102	General	2005Q	Nonspecific chronic pain	Scandinavia(Sweden)	R/L	Pain of at least 3 months duration	46	NR	NR	42.57-49.47
29	Vieira et al⁴⁸, 2012	1597	1060	537	>= 18	General	2009-2010I	Nonspecific chronic pain	South America	R/L	Persistent pain for more than 6 months	42	49.4	28.4	39.59-44.48
30	Shmegal et al⁴⁹, 2016	5103	2592	2511	22-69	General	2009-2010I	CLBP	USA	N	Lower back pain almost every day lasting >= 3months	13.1	55.8	NR	12.15-14.02
31	Johannes et al⁵⁰, 2010	27035	16678	10357	>= 18	General	2008-2009Q	Nonspecific chronic pain	USA	N	"Chronic and long-lasting recurrent pain" lasting >= 6 months ‘not fleeting or minor’	30.7	34.3	26.7	30.15-31.25
32	Jonsdottir et al⁵¹, 2013	1548	875	673	20-70	General	NRQ	Nonspecific chronic pain	Iceland	N	Pain lasting >= 3 months	47.5	50.5	46.2	44.94-50
33	Silva et al⁵², 2020	1300	736	564	>= 18	General	2016I		South America	R/L	Pain in the cervical, thoracic or lumbar regions lasting >= 3months	20.7	26	13.7	18.52-23
34	Bergman et al⁵³, 2001	2425	NR	NR	20-74	General	1995 Q	CWP	Sweden	N	Persistent or regularly recurrent pain for more than 3 months during the last 12 months (and in accordance with ACR criteria 1990)	11.4	NR	NR	10.15-12.72
35	Meucci et al⁵⁴, 2013	1732	1581	1151	>= 20	General	2010 I	CLBP	South America	R/L	Pain lasting >= months in the lumbar region	9.6	11.7	6.6	8.07-10.91
36	Nakamura et al⁵⁵, 2011	11507	6365	5142	>= 18	General	2010Q	Chronic Musculo-skeletal	Japan	N	Pain associated with bone, muscle, joints or nerve; lasting >= 6 months; present within the past month; >= 5 on 10-points VAS scale	15.4	16.8	13.6	14.68-1601
37	Jhun et al⁵⁶, 2009	2929	1713	1216	>= 20	General	2007Q	CBP	Korea	N	Back pain lasting >= 3months in the past year	15.4	18.4	12.2	14.11-16.76
38	Ablin et al⁵⁷, 2012	1019	519	500	>= 18	General	NRQ	FM	Israel	N	Persistent pain for more than 3 months (and in accordance with ACR criteria 1990)	2.6	7.1	3.0	3.86-6.67
39	Lourenco et al⁵⁸, 2015	1719	883	836	>= 21	General	2011-2013Q	FM	Portugal	N	Widespread pain index (WPI) and symptom severity scale (SSS) score were both above the cut off points and symptoms present at a similar level for >= 3months	1	1.4	0.6	0.58-1.58
40	Mundal et al⁵⁹, 2014	3770	2540	1230	>= 20	General	2006-2008Q	CWP	Norwegian	N	Pain at three or more predefined sites (Involving the trunk and upper and lower limb) for at least 3 months in the last year	52.9	56.9	42.27	51.28-54.50
41	Aggarwal et al⁶⁰, 2006	2299	NR	NR	18-75	General	2003-2004Q	CWP	North-WestEngland	R/L	Defined according to the American College of Rheumatology (ACR) criteria for classificationof widespread pain for fibromyalgia; Briefly, the criteria require the presence of pain in the left and right side of the body, pain above and below the waist, and pain in the axial skeleton (Cervical spine anterior chest, thoracic spine or low back)	15	NR	NR	13.57-16.53
42	Jackson et al⁶¹, 2014	1003	401	602	>= 18	General	NRI	Nonspecific chronic pain	Asia(ChongquingChina)	R/L	Pain lasting >= 3 months	25.8	NR	NR	23.16-28.67
43	Landmark et al⁶², 2019	3105	1728	1377	> 20	General	2008-2012Q	CWP	Scandinavia (Sweden)	R/L	Scandinavia (Sweden)	6.9	9.6	3.6	6.03-7.85
44	Harifi et al⁶³, 2013	5116	3638	1488	>= 18	General	2009I	Nonspecific chronic pain	Moroccan	N	Daily pain for at least 3 months	21	12.5	5.8	19.87-22.12
45	Duenas et al⁶⁴, 2015	1957	986	971	>= 18	General	2011I	Nonspecific chronic pain	Spain	N	Pain (at least 4 days a week) during the last 3 months	16.6	24.8	8.2	14.99-18.34
46	Gerdle et al⁶⁵, 2004	7637	4014	3623	18-74	General	1999Q	Nonspecific chronic pain	Sweden	R/L	Pain lasting for > 3 months	53.7	58.7	48.2	52.57-54.82
47	Bilbeny et al⁶⁶, 2018	865	NR	NR	>= 18	General	2013I	Nonspecific chronic pain	Santiago (South America)	R/L	Pain lasting >= 3 months, not related with previously diagnosed cancer	32.1	32.9	30	29.05-35.38
48	Elzahaf et al⁶⁷, 2016	1212	662	550	>= 18	General	2010I	Nonspecific chronicpai	Libya	R/L	Pain lasting >= 3 months	19.6	24	14	17.43-21.98
49	Sa et al⁶⁸, 2009	2297	1272	1025	>= 20	General	1999-2000 Q	Nonspecific chronic pain	Salvador (Northeast Brazil)	R/L	Pain lasting for more than 6 months (IASP criteria)	41.4	48.4	32.8	39.37-43.45
50	Ferriera et al⁶⁹, 2016	2446	1514	932	>= 18	General	NRI	Nonspecific chronic pain	Saopaulo (Brazil)	R/L	Persistent pain at least for 3 months	28.1	34.7	20.6	26.32-29.92
51	Leyva et al⁷⁰, 2022	502	253	249	18-70	General	2017Q	Non pecific chronic pain	Lima Peru	R/L	Persistent pain in last 3months	38.5	48.9	51.1	34.20-42.87
52	Rikard et al⁷¹, 2023	29482	NR	NR	>= 18	General	2021 Q	Nonspecific chronic pain	US	N	Pain lasting >= 3 months	20.9	22	19.7	20.43-21.36

T, total; M, male; F, female; General, general population; R/L, regional/local; N, national; NR, not reported; CLBP, chronic lower back pain; CBP, chronic back pain; CWP, chronic widespread pain; FM, fibromyalgia; I, interview; Q, questionnaire

Characteristics of the included studies

A total of 52 included studies were published between 2004 and 2024. Number of participants across the studies ranged from 145 to 33,028, including a total of 2,89,490 participants. The studies, based on the types of chronic pain as were categorised as follows: non-specific chronic pain, fibromyalgia, chronic lower back pain, chronic back pain, chronic widespread pain, and chronic musculoskeletal pain. Geographical regions were categorised according to: Asia (17 studies), Europe (19 studies), South America (8 studies), North America (5 studies), and Africa (3 studies).

Quality assessment

Twelve studies from 52 were ‘low-risk’, 19 were ‘moderate-risk’, and 21 were “high risk”. The sample size calculation was found adequate in 50% of the studies. The participant rate was a major bias criterion in this study; less than 25% of studies stated a more than 85% participation rate. The two-rater interaction agreement was assessed (between NS and GTC) by Kappa with and a value of 0.915 [95% CI 0.82 to 1.00] was obtained. The value being greater than 0.9 shows excellent agreement. There were four discrepancies between the two independent raters which was sorted out by consultation with the third author (GTC). Figure 2 depicts the summary and individual risk of bias.

Depicting summary plot for risk of bias.

Pooled prevalence of chronic pain

The estimated prevalence percentage varied widely, and heterogeneity among the studies was 99.8%. The random-effects meta-analysis pooled estimate of the prevalence percentage of all the studies was 26.99% (95% CI: 22.32 to 31.93). The prevalence percentage among the studies ranged from1% to 77.0% and I² on calculation was 99.8%, Q (51) is 28823.29, P<0.001. By removing the single data point at one time in the sensitivity analysis, the pooled prevalence percentage ranged from 27.70% (95% CI: 23.58 to 31.82) to 29.04% (95% CI: 24.64 to 33.32) (Table II).

Table II. Pooled and stratified prevalence of chronic pain

	No. of studies (k)	Prevalence % (95% CI)	I², %	Q-tests
Overall pooled prevalence	52	26.99 (22.32 to 31.93)	99.8	Q(51)=28823.29 P<0.001
Chronic pain type		Stratified prevalence
Nonspecific	34	34.08 (29.18 to 39.16)	99.8	Q(5)=104.92 P<0.001
Chronic lower back pain	5	15.41 (7.63 to 25.28)	99.6
Chronic back pain	3	24.22 (12.36 to 38.55)	99.8
Chronic widespread pain	4	19.36 (4.55 to 41.11)	99.9
Fibromyalgia	3	2.57 (0.78 to 5.332)	99.3
Chronic musculoskeletal pain	3	18.51 (4.13 to 40.01)	99.9

Meta-analysis stratified by the various pain conditions

Stratified prevalence of chronic pain according to the type of pain: According to the pain condition, the prevalence rates varied significantly (Table II). The heterogeneity index and I² statistics showed a higher heterogeneity among the prevalence rates within each subtype (Supplementary Figure).

Supplementary Figure

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Prevalence of chronic pain according to geographic region

The prevalence rates according to the geographic region, were almost similar (Q_B(4)= 1.19, P=0.879). The highest prevalence percentage was observed in South America; 29.48% (95% CI: 21.55 to 38.0), followed by Europe; 27.72% (95%CI: 18.08 to 38.52), Asia; 26.46% (95% CI:18.45 to 35.33) and the lowest prevalence rate was in North America as 23.52% (95% CI: 16.28 to 31.64).

Subgroup analysis according to the method of data collection

The data on chronic pain were collected through either interviews or questionnaires. In the interview-based method, the pooled prevalence percentage was 27.60% (95% CI: 19.80 to 34.01) and in the questionnaire-based method, it was 21.55% (21.54 to 33.57) which was not significantly different.

Pooled prevalence according to sampling area

We categorised the sampling area into two categories, national and regional or local, where 59.25% of studies belonged to the former and 40.75% to the latter. In the national sampling area, the prevalence percentage was 25.69% (95% CI: 19.26 to 32.69) while it was 29.96% (95% CI: 23.63 to 35.74), in the regional sampling areas, indicating, no statistically significant regional difference.

Pooled prevalence according to risk of bias

The overall combined chronic pain prevalence was compared according to the quality of categories, ‘low-risk’, ‘moderate-risk’, and ‘high-risk’ which did not vary significantly (Q_B(2)=1.32, P=0.5168).

Prevalence of chronic pain according to gender

The pooled prevalence percentage of various types of chronic pain was 21.63% (95% CI:16.68 to 27.02) among males and 31.42% (95% CI:25.48 to 37.69) in females (P=0.017) (Supplementary Table II).

Supplementary Table II

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Sensitivity analysis

It was done to test different assumptions pertaining to missing data to see if the results hold, thereby strengthening evidence quality. Additionally, to obtain robust estimates of the pooled effect size, especially as heterogeneity of the meta-analysis was high. The range of chronic pain varied from 26.11% (95% CI:21.72 to 30.75%) to 27.70% (95% CI:23.02 to 32.58%).

Age variation

In the present study, Age-specific meta-analysis was not possible as most of the included studies had used different age cut-off points. A total of 45 studies covered the ≥18 yr age group, and in 7 studies, patients were ≥45 years of age. The chronic pain prevalence percentage was statistically significant (Q(B)=6.67; P<0.001), in the ≥18 years age group it was 24.23% with I²=99.8% and in the ≥ 45 years the chronic prevalence percentage of all types of pain was 46.68% with I²=99.9%.

Publication bias

Visual assessment of funnel plot symmetry for the overall analysis did not indicate evidence of publication bias. This finding was supported by the Egger regression test, which was not statistically significant (intercept=3.947; 95% CI: −16.17 to 8.28; P=0.29), as well as by the Begg and Mazumdar rank correlation test (P=0.670). Inspection of the funnel plot for the non-specific chronic pain meta-analysis also suggested no apparent publication bias. The Egger regression test for this analysis was also non-significant (intercept=6.43; 95% CI: 5.42 to 19.29; P=0.273), and the Begg and Mazumdar test did not demonstrate statistical significance (P=0.172).

Discussion

Our analysis demonstrated an overall pooled prevalence of chronic pain of 26.99% using a random-effects model. A greater pooled prevalence of chronic pain across all categories was noted among females compared with males (31.42% vs. 21.63%). This is in contrast to the recent systematic review by Murray et al¹⁴ who noticed that chronic pain did not vary according to gender.¹⁴ Our findings align with those reported by Mansfield et al⁷², who also demonstrated a significantly higher prevalence of chronic pain among females.

Women have also been found to be suffering from under-treatment of chronic pain pertaining to gynaecological malignancies, highlighting the need for a targeted approach for all phases of palliative care.⁷³

Like the present study, two meta-analysis, estimating the prevalence of all types of chronic pain, were conducted; one in young adults by Murray et al¹⁴ and the other by Jackson et al³ in the adult general population with an overall pooled random-effect prevalence of 11.6% in the former and a range of 6% to 48% in the latter. A recent analysis found chronic multi-site pain to be common in adolescents, particularly those with attention-deficient hyperactivity disorder, with a higher prevalence in the general population and greater rates in females than males. This highlights the association of chronic pain with co-morbid conditions and strengthens the gender-based differences, like the present meta-analysis.74

In contrast, only a limited number of studies have examined the prevalence of specific chronic pain conditions, such as chronic low back pain. One such study from Benin, West Africa, reported a high prevalence of chronic lower back pain in both urban (30.68%) and rural (40.2%) populations, with significant associations observed with age, marital status, and employment status.²³ Another meta-analysis⁷⁵ conducted among African school teachers found a pooled prevalence of chronic low back pain 59%. This highlights the need to endorse therapeutic modalities for pain management in developing nations.

A similar prevalence of chronic widespread pain was observed by Andrews et al¹³ on combining the data from Europe and America, which revealed it to be 8.9% and 10.9%, respectively. These findings are in concordance with the current study, where the prevalence rates were similar across geographic regions in the age group 18-95 years. In contrast, Murray et al¹⁴ reported considerable geographic variation in chronic pain prevalence, with the highest rates observed among young adults in Australia and South America (13.6%) and the lowest rates reported in Central and Western Europe (7.8%).¹⁴ The difference could be because the current meta-analysis included the general population and not a specific subset of individuals. Also, the prevalence of chronic widespread pain has been estimated more in women as compared to men in previous studies, a finding like ours.13,14,73,74

The present study dealt with a few limitations. Given the considerable heterogeneity identified in this systematic review and meta-analysis, likely stemming from differences in patient characteristics, the results should be interpreted cautiously. Future studies on the prevalence of chronic pain should emphasise stratified reporting by age, sex and provide detailed methodological and statistical measures to facilitate robust data pooling. Systematic reviews and meta-analysis evaluating chronic prevalence in different chronic pain conditions, non-specific chronic pain, migraine, postherpetic neuralgia, type-2 diabetes mellitus, and cancer pain are warranted. Also, standardised definitions of chronic pain while reporting would help to reduce heterogenicity in data.

To conclude, this systematic review and meta-analysis estimated the global pooled prevalence of chronic pain among adults aged 18–95 years to be 26.99%, with a higher prevalence observed in females and no notable differences across geographical regions.

Author contributions

AS: Concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript writing; NS: Literature search, clinical studies, experimental studies, and data acquisition; GC: Definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, manuscript writing; MG: Manuscript writing; RM: Data analysis and statistical analysis. All authors have read and approve the final printed version of the manuscript.

Financial support and sponsorship

None.

Conflicts of Interest

None.

Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation

The authors confirm that there was no use of AI-assisted technology for assisting in the writing of the manuscript and no images were manipulated using AI.

References

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[1] Saxena AK, Jain PN, Bhatnagar S. The prevalence of chronic pain among adults in India. Indian J Palliat Care.. 2018;24:472-7.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[2] Lipman AG. Pain as a human right: The 2004 global day against pain. J Pain Palliat Care Pharmacother.. 2005;19:85-100.
[PubMed] [Google Scholar]

[3] Jackson T, Thomas S, Stabile V, Shotwell M, Han X, McQueen K. A systematic review and meta-analysis of the global burden of chronic pain without clear etiology in low- and middle-income countries: Trends in heterogeneous data and a proposal for new assessment methods. Anesth Analg.. 2016;123:739-48.
[CrossRef] [PubMed] [Google Scholar]

[4] Enright A, Goucke R. The global burden of pain: The tip of the iceberg? Anesth Analg. 2016;123:529-30.
[CrossRef] [PubMed] [Google Scholar]

[5] Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain.. 2015;16:769-80.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[6] Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain.. 2008;136:380-7.
[CrossRef] [PubMed] [Google Scholar]

[7] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain.. 2006;10:287-333.
[CrossRef] [PubMed] [Google Scholar]

[8] Ohayon MM, Stingl JC. Prevalence and comorbidity of chronic pain in the German general population. J Psychiatr Res.. 2012;46:444-50.
[CrossRef] [PubMed] [Google Scholar]

[9] Hardt J, Jacobsen C, Goldberg J, Nickel R, Buchwald D. Prevalence of chronic pain in a representative sample in the United States. Pain Med. 2008;9:803-12.
[CrossRef] [PubMed] [Google Scholar]

[10] Bannwarth B, Blotman F, Roué-Le Lay K, Caubère JP, André E, Taïeb C. Fibromyalgia syndrome in the general population of France: A prevalence study. Joint Bone Spine.. 2009;76:184-7.
[CrossRef] [PubMed] [Google Scholar]

[11] Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, et al. Prevalence of fibromyalgia: A survey in five European countries. Semin Arthritis Rheum.. 2010;39:448-53.
[CrossRef] [PubMed] [Google Scholar]

[12] Dureja GP, Jain PN, Shetty N, Mandal SP, Prabhoo R, Joshi M, et al. Prevalence of chronic pain, impact on daily life, and treatment practices in India. Pain Pract.. 2014;14:E51-62.
[CrossRef] [PubMed] [Google Scholar]

[13] Andrews P, Steultjens M, Riskowski J. Chronic widespread pain prevalence in the general population: A systematic review. Eur J Pain.. 2018;22:5-18.
[CrossRef] [PubMed] [Google Scholar]

[14] Murray CB, de la Vega R, Murphy LK, Kashikar-Zuck S, Palermo TM. The prevalence of chronic pain in young adults: A systematic review and meta-analysis. Pain.. 2022;163:e972-84.
[CrossRef] [PubMed] [Google Scholar]

[15] Sá KN, Moreira L, Baptista AF, Yeng LT, Teixeira MJ, Galhardoni R, et al. Prevalence of chronic pain in developing countries: Systematic review and meta-analysis. Pain Rep.. 2019;4:e779.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[16] Ramanjulu R, Thota RS, Ahmed A, Jain P, Salins N, Bhatnagar S, et al. Indian society for study of pain, cancer pain special interest group guidelines on pharmacological management of cancer pain (Part i) Indian J Palliat Care.. 2020;26:173-9.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[17] Stubhaug A, Hansen JL, Hallberg S, Gustavsson A, Eggen AE, Nielsen CS. The costs of chronic pain-Long-term estimates. Eur J Pain.. 2024;28:960-77.
[CrossRef] [PubMed] [Google Scholar]

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Prevalence of chronic pain in the general population: A systematic review and meta-analysis

Abstract

Background and objectives

Methods

Results

Interpretation and conclusions

Keywords

Chronic pain

Fibromyalgia

Meta-analysis

Migraine

Prevalence

Systematic review

Methods

Search strategy

Inclusion and exclusion criteria

Screening and Selection of relevant studies

Data extraction and management

Outcome measures

Quality assessment

Qualitative assessment

Statistical analysis

Results

Literature search

Characteristics of the included studies

Quality assessment

Pooled prevalence of chronic pain

Meta-analysis stratified by the various pain conditions

Prevalence of chronic pain according to geographic region

Subgroup analysis according to the method of data collection

Pooled prevalence according to sampling area

Pooled prevalence according to risk of bias

Prevalence of chronic pain according to gender

Sensitivity analysis

Age variation

Publication bias

Discussion

Author contributions

Financial support and sponsorship

Conflicts of Interest

Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation

References

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