The Journals of Gerontology, Series B · Oct 30, 2025

Beyond pain presence: the impact of multisite pain and pain interference on cognitive functioning among middle-aged and older adults

By Yu C, Barr AB, Yang Y et al.

OBJECTIVES: This study investigates the relationship between chronic pain and cognitive function in the U.S. middle-aged and older population, focusing on the impact of the number of pain sites. It also explores whether pain interference mediates the association between pain sites and cognition. METHODS: Data were drawn from the 2004-2006 and 2013-2017 waves of the Midlife in the United States Study (MIDUS 2 and MIDUS 3, N = 2,219). We fit inverse-probability-weighted models to examine the associations between pain status, number of pain sites (none vs. 1-2 vs. 3+ sites), and cognitive function in MIDUS 3, controlling for confounders from MIDUS 2. The Sobel-Goodman mediation test with Bonferroni-adjusted significance level was applied to assess the mediating role of pain interference in five domains: activities, mood, relationships, sleep, and enjoyment. RESULTS: Among those with chronic pain, 40% report pain in three or more sites. There was no significant difference in cognitive function between individuals with and without chronic pain. However, individuals with pain in 3+ sites had significantly poorer cognitive function than those with no pain or pain in 1-2 sites. Pain interference significantly mediated over 50% of this association, with social relations being the strongest mediator, followed by mood. DISCUSSION: The mere presence of chronic pain may not significantly affect cognitive function, but having multi-site pain could be a risk factor for cognitive decline in later life. Addressing multi-site pain and/or pain interference in psychosocial dimensions may help protect cognitive health.

doi.org/10.1093/geronb/gbaf220Open accessPubMed 41165600Populations