In later life, women and socio economically disadvantaged adults face higher risk of recurring and worsening pain, ELSA study finds

New research using two decades of ELSA data shows that pain in later life often fluctuates over time and that women and people with lower education and wealth are more likely to experience persistent or returning moderate to severe pain.

The paper, published in Age and Ageing, analysed 21 years of data from 9,369 adults aged 50 to 98. Rather than assuming pain steadily worsens or improves over time, the researchers examined how people moved between different states of pain, defined as moderate to severe pain, mild pain, and no pain, over time.

The findings show that pain in later life is highly changeable. This doesn’t mean pain is short-lived; rather, many people live with long-term pain that fluctuates in severity over time. Over the study period, participants experienced more than 17,000 transitions between pain states, and fewer than one in five remained in the same state throughout follow-up.

Around a quarter of all transitions were from moderate to severe pain to no pain, while substantial numbers also moved back into moderate to severe pain after a period without pain.

Women were less likely than men to experience improvements in pain severity or full remission from moderate to severe pain. They were also substantially more likely to experience a recurrence of moderate to severe pain after a pain free period.

Socioeconomic factors showed a similar pattern. Higher levels of education were linked with a greater likelihood of pain improvement and remission, and a lower risk of worsening or recurring pain. Greater household wealth was also associated with more favourable pain trajectories, including lower risk of worsening pain and higher likelihood of improvement.

Lead author Dr Mikaela Bloomberg (UCL Department of Epidemiology and Public Health) said:

“Pain in older age is not something that only moves in one direction. Many people shift between worse and better states over time, including periods without pain followed by relapse. We already know women and socioeconomically disadvantaged groups are more likely to develop pain in the first place; what this study adds is that these inequalities also shape what happens after pain begins—who improves, who recovers, and who experiences pain again.”

Chronic pain is common in later life and has major impacts on quality of life, disability, and health service use. The study highlights that focusing only on pain onset may be insufficient to address inequalities because disadvantaged groups are less likely to recover and more likely to relapse.

The authors suggest that pain management strategies may benefit from proactive follow-up and monitoring, with particular attention to women and people with fewer socioeconomic resources.

Bloomberg M, Bu F, Fancourt D, Steptoe A. Demographic and socioeconomic risk factors for pain progression and recurrence in middle-aged and older adults: multistate analysis of a prospective English cohort study. Age Ageing. 2026;55(1); PMCID: PMC12763816

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