Pain is associated with higher odds of sarcopenia in middle-aged and older adultsChronic Pain Linked to Higher Risk of Muscle Loss

BackgroundSarcopenia contributes substantially to functional decline in middle-aged and older adults. Pain is common in this population and may be associated with impaired muscle health; however, the magnitude and clinical characteristics of this association remain uncertain. This systematic review and meta-analysis aimed to quantify the association between pain and sarcopenia-related outcomes in middle-aged and older adults.MethodsPubMed, Embase, Web of Science, and the Cochrane Library were searched from database inception to April 10, 2026. Observational studies involving adults aged ≥50 years, or populations with a mean age of ≥50 years, that reported the association between pain and sarcopenia-related outcomes were included. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random-effects models, with between-study variance estimated by the restricted maximum likelihood method. Subgroup and secondary meta-analyses were conducted according to consensus-based sarcopenia criteria, pain severity, and anatomical pain site. Studies using SARC-F were excluded from the corresponding main analyses and were considered only in separate sensitivity analyses. Leave-one-out sensitivity analyses, funnel-plot inspection, and Egger's regression test were also performed. The review was registered in PROSPERO (CRD420261406169).ResultsNine observational studies were included in the systematic review, of which six studies using consensus-based sarcopenia criteria contributed to the primary meta-analysis. Pain was significantly associated with higher odds of sarcopenia (pooled OR = 1.26, 95% CI: 1.16–1.38; p < 0.001), with low between-study heterogeneity (I2 = 1.43%). No significant difference was observed between studies using the AWGS 2019 and EWGSOP2 criteria (p for subgroup difference = 0.83). The pooled ORs were 1.33 (95% CI: 1.07–1.65) for mild pain, 1.49 (95% CI: 1.17–1.89) for moderate pain, and 2.17 (95% CI: 1.32–3.57) for severe pain. Back or low-back pain and joint or knee pain were also positively associated with sarcopenia, with pooled ORs of 1.72 (95% CI: 1.28–2.31) and 1.78 (95% CI: 1.12–2.83), respectively. In a sensitivity analysis of the overall pain association, inclusion of PPB 2022, which used SARC-F, increased the pooled OR to 1.56 (95% CI: 1.06–2.31), markedly increased heterogeneity (I2 = 94.24%), and reduced result stability. In a separate site-specific sensitivity analysis, inclusion of CLC 2025 yielded a pooled OR of 1.95 (95% CI: 1.30–2.91) for joint or knee pain, and the positive direction of the association was maintained in the corresponding leave-one-out analysis. Egger's test did not indicate statistically significant small-study effects (p = 0.533), although its power was limited by the small number of studies.ConclusionPain was associated with higher odds of sarcopenia and sarcopenia-related outcomes in middle-aged and older adults. Positive associations were also observed for severe pain and for site-specific back or low-back pain and joint or knee pain in analyses restricted to studies using consensus-based sarcopenia criteria, although substantial heterogeneity in several secondary analyses warrants cautious interpretation. Sensitivity analyses incorporating SARC-F-based studies yielded positive pooled estimates; however, screening-defined risk of sarcopenia should not be considered equivalent to sarcopenia confirmed using consensus-based criteria. Given the observational nature of the evidence, causal conclusions cannot be drawn. These findings support consideration of sarcopenia screening and physical-function assessment among middle-aged and older adults with persistent or clinically significant pain.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261406169, identifier [CRD420261406169].