Aging
Mapping Thirty–Year Pain Trajectories in Later Life: Sequence Analysis of U.S. Middle-aged and Older Adults in the Health and Retirement Study Muxi Zheng* Yulin Yang Yang Yang Yang Yang Yang Yang Yang Yang Yang University of California, San Francisco
Pain is highly dynamic, yet little is known about how its timing, order, and duration vary across the life course. This study uses sequence analysis to identify longitudinal patterns of pain over 30 years among middle-aged and older adults.
We analyzed data from 30,728 participants aged 55-85 in the US Health and Retirement Study (HRS, 1992-2022). Pain status and severity were self-reported at each survey wave, operationalized as no pain, mild pain, moderate pain, severe pain, unknown, and deceased. We carried forward pain categories between wave years. We used sequence analysis to quantitatively compare individual pain trajectories, and hierarchical agglomerative clustering to group similar trajectories.
We identified 20 distinct pain trajectory clusters (Figure 1) over 30 years across 16 waves. These trajectories varied substantially in timing of onset, pain persistence, severity progression, and stability of pain over time. To enhance interpretability, the 20 types were collapsed into five meta-groups: persistently low or no pain (49.5%; Types 1, 4, 8,13), early-onset persistent pain (14.4%; Types 6, 7, 10, 15), late-onset pain (14.9%; Types 3, 5, 11, 17), intermittent pain (11.3%; Types 2, 9, 14, 16, 20), and progressively worsening pain (9.9%; Types 12, 18, 19). While mild and severe pain patterns were largely intermittent, a greater number of individuals experienced moderate pain for extended durations.
Middle-aged and older adults report a diverse experience of pain patterns over time, including age when pain begins, duration and severity, and whether it worsens, improves, or is intermittent. By tracing comprehensive pain histories rather than relying on snapshots, sequence analysis makes this diversity visible. Determinants and consequences of these trajectories may vary widely, and understanding which trajectory an individual is experiencing may inform pain prevention and care.
