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Abstract

Background
Pain is a universal problem, with millions of people around the world experiencing some kind of pain. Despite its importance, rigorous longitudinal evidence on the longer-term effects of pain across various countries remains scarce.

Methods
This study takes one step toward addressing this gap by examining how pain predicts 56 diverse wellbeing and life-related outcomes using longitudinal data from 22 countries and one territory from Wave 1 and Wave 2 of the Global Flourishing Study (N = 207,919). Country-specific regression analyses were conducted, with estimates pooled using random-effects meta-analyses.

Results
Adjusting for demographic and childhood factors, we find that pain in Wave 1 negatively predicts flourishing, happiness, life satisfaction, inner peace, mental health, purpose, relationship satisfaction, belonging, orientation to promote good, delayed gratification, hope, gratitude, showing love, physical health, physical exercise, financial and material security, financial comfort, owning home, and being in the top income quintile in Wave 2. Conversely, pain in Wave 1 positively predicts higher traumatic distress, anxiety, depression, suffering, loneliness, perceived discrimination, health problems, and pain in Wave 2. Pain in Wave 1 has the largest positive effects on subsequent pain, health problems, and suffering, and the largest negative effects on subsequent secure flourishing, mental health, and financial security.

Conclusions
This study offers some of the most comprehensive country-wide evidence to date on the potential enduring impact of pain, providing valuable insights for policymakers, healthcare providers, and global organisations focused on reducing health inequalities and enhancing human wellbeing.

Publication Type:	Article
Additional Information:	© The Author(s) 2026. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/bync-nd/4.0/.
Subjects:	H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Psychology & Neuroscience
SWORD Depositor:	Symplectic Administrator

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