| Sumario: | Background While demographic and socioeconomic factors such as female sex and socioeconomic disadvantage are well-established risk factors for pain onset, previous studies examining long-term pain trajectories give mixed results and often overlook how pain fluctuates. This study identified demographic and socioeconomic risk factors for pain progression, remission and recurrence using multistate models to capture the dynamic nature of long-term pain. Methods Data were drawn from 9369 adults aged 50–98 from the English Longitudinal Study of Ageing (study years: 2002/03–2021/23). The baseline wave for each participant was their first wave of pain (moderate–severe or mild pain). Pain severity at subsequent waves was categorised into three states: (i) moderate–severe; (ii) mild; or (iii) none. We used multistate models to examine associations of demographic and socioeconomic factors with pain improvement (state 1–2), worsening (state 2–1), remission (state 1–3) and recurrence (state 3–1). Results Findings particularly highlighted sex and socioeconomic disparities: compared with males, females were less likely to experience pain improvement (hazard ratio [HR] = 0.84, 95% confidence interval = 0.74–0.96) or remission (HR = 0.72, 0.64–0.80), and more likely to experience recurrence (HR = 1.45, 1.25–1.68). More education was associated with pain improvement (HR = 1.43, 1.16–1.76) and remission (HR = 1.30, 1.07–1.58), and lower risk of worsening (HR = 0.52, 0.42–0.64) and recurrence (HR = 0.67, 0.52–0.85); similar patterns were observed for wealth, with greater wealth associated with more favourable pain trajectories. Conclusion Pain fluctuates over time, following socially patterned trajectories, with women and socioeconomically disadvantaged individuals more likely to experience persistent or recurring pain. These findings highlight the importance of risk-stratified approaches, including proactive monitoring and management.
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