University of Sydney researchers are launching a national trial of Pain Smart, a school-based pain education program designed to help young people understand and manage persistent pain and remain engaged in school, sport, and everyday activities. 

The Medical Research Future Fund-supported program comes as an international team of researchers publishes major global research that finds chronic pain often begins much earlier in life than is often assumed.

It found around one in six teenagers live with chronic pain, and it is one of the leading reasons young people miss school, sport, and other everyday activities. By the age of five, 30 percent of children were estimated to experience pain on at least one part of the body. It also found pain across most body regions increased most rapidly before midlife. 

Headaches and abdominal pain were found to emerge earliest in life, while back, hip and knee pain tended to increase progressively through adulthood. The researchers also noted that pain in children and adolescents remains under-studied globally, despite growing evidence that early-life pain can have long-term consequences, suggesting health systems prioritise earlier prevention and education. 

Published in Nature Medicine, the research analysed data on over 6.1 million individuals across 119 countries to assess pain across a person’s lifespan. It provides one of the most comprehensive pictures to date of how pain develops across the lifespan.

Dr Tiê Yamato, a co-author of the study and coordinator of the Pain Smart trial, said the findings challenge the common belief that chronic pain is primarily a problem of older age: 

 "Chronic pain is often thought of as something that happens later in life, but our research shows pain can begin much earlier, including during childhood and adolescence.

"That matters because the earlier pain starts, the greater the opportunity for it to affect education, social development, physical activity and quality of life. For many young people, pain can disrupt some of the most important experiences of adolescence, from attending school and playing sport to spending time with friends and developing independence."

Dr Yamato has seen first-hand the impact of pain conditions like juvenile arthritis and endometriosis on young people and their families.

"Young people with persistent pain are often told they are too young to have serious pain, or that what they're experiencing can't be that bad. Not being believed can be incredibly isolating. The stigma associated with pain can sometimes be just as difficult as the condition itself."

One young person living with chronic pain is 16-year-old Kayden from Port Macquarie, who was first diagnosed at age 10 with juvenile idiopathic arthritis – the most common type of chronic arthritis in children under the age of 16, causing persistent joint swelling, pain, and stiffness. His diagnosis has since expanded to include enthesitis-related and polyarticular arthritis, affecting multiple joints including his fingers which led him to give up martial arts.

“Often, it’s the sense of not being believed which is the worst. I might look completely fine on the outside, all the while I’m actually dealing with a lot of pain, fatigue and medication side effects. I've been told by doctors, ‘you should be fine’ when scans have come back normal, meanwhile my symptoms haven’t reduced.”

Pain Smart will bring evidence-based education into Australian classrooms through a three-lesson module co-developed with adolescents, teachers, and researchers, aiming to improve pain literacy and help young people remain engaged in school, sport, and everyday activities.

“Evidence shows that young people often misunderstand what pain is and how it works. Our education program will give them skills to manage their pain better, understand what is happening for their classmates who are experiencing pain and reduce the long-term impact on health,” said Professor Steve Kamper, who leads the Pain Smart team.

The program also provides practical tips and strategies to support healthy self-management, such as reducing stress.

“Stress can really amplify my pain – I feel much better when I'm relaxed,” said Kayden. “A lot of stress has come from not knowing how to manage day-to-day, with no clear ‘manual’ for how to navigate life between appointments and treatments. But when I’m outside and in nature, that’s when I feel my best.”

The researchers are now recruiting secondary schools across Australia to participate in the Pain Smart study and are looking for opportunities to raise awareness of adolescent pain and the importance of pain literacy. For more information, visit this link.

Research:

Fillingim M. et al., Global and regional reference curves for pain across the lifespan in 6.1 million individuals in 118 countries, Nature Medicine (2026). 

Declaration:

The University of Sydney authors declare no conflicts of interest. The research was supported by the Canadian Institutes of Health Research (RN441786–453096), the Fonds de recherche du Québec en Santé (283687), the Réseau québécois de recherche sur la douleur and the Louise and Alan Edwards Grants in Pain Research and by the Louise and Alan Edwards Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.