Chronic Pain

Chronic pain can be hard to make sense of. It can affect your child’s sleep, energy, school, friendships, and mood. It can also be stressful for the whole family. The most important thing to know is this: chronic pain is real, and support can help.

Key Messages

• Chronic pain usually means pain that lasts longer than three months
• Chronic pain is common in young people and can affect daily life in many ways
• Research suggests trans young people are more likely to experience chronic pain than their cisgender peers
• Stress from stigma and discrimination can make pain more likely and can also make pain harder to manage
• A gender-affirming, trauma-informed approach can make a real difference

What is Chronic Pain?

Chronic pain usually refers to pain that lasts longer than three months.¹ It can be constant, or it can come and go. It can show up as headaches, migraines, muscle pain, joint pain, stomach pain, widespread pain, or pain linked to another health condition.² Up to 20.8% of young people report chronic pain. Common types include chronic headaches and musculoskeletal pain.³ Chronic pain can impact:

• Sleep and fatigue
• School attendance and learning
• Social life and hobbies
• Mood, including anxiety and depression symptoms
• Movement and physical activity²

Sometimes chronic pain is linked to an injury or health condition. Other times, pain continues even when tests do not show clear damage. This can happen when the nervous system becomes more sensitive over time. Researchers often describe this as central sensitisation. It means the brain and spinal cord become more reactive, so pain signals are amplified and harder to switch off.⁴

This does not mean the pain is made up. It means the pain system has become overprotective.

How common is chronic pain in trans young people?

Research suggests trans young people report chronic pain more often than cisgender peers.³ In one study, 34% of young people presenting to paediatric pain clinics were trans.³ Common chronic pain diagnoses reported among trans young people in current research include:

• Fibromyalgia
• Headaches and migraines
• Ehlers-Danlos syndrome or joint hypermobility²

Why are trans young people at higher risk?

There is no single cause. Chronic pain is usually influenced by a mix of body factors, nervous system factors, mental health, and life stress.^2,3,4 Trans young people may face extra stressors and barriers that increase risk or worsen pain.

Minority stress and discrimination

Trans young people may experience rejection, bullying, discrimination, invalidation, and barriers to healthcare. These are often described as minority stressors.^1,2,3,4 Over time, chronic stress can affect the body and the nervous system. It can disrupt sleep, increase muscle tension, increase inflammation, and keep the nervous system in a heightened threat state, which can make pain more intense or more persistent.^2,3 One study found that trans young people who experienced discrimination were around twice as likely to report chronic pain compared to trans young people who did not report discrimination. ⁵

Mental health and trauma

Chronic pain often overlaps with anxiety, depression, and post-traumatic stress symptoms. These can intensify pain through mechanisms like catastrophising, hypervigilance, and reduced coping capacity.^3,4 For trans young people, the combination of minority stress and mental health symptoms can create a difficult cycle: pain increases distress, and distress increases pain.^3,4 This is one reason trauma-informed care can be so important.¹

Gender dysphoria and body stress

Gender dysphoria can increase distress in everyday body-related situations such as clothing, movement, sport, changing rooms, medical care, and fear of being misgendered. This can increase muscle tension, protective posture, avoidance, and bodily vigilance, which can amplify pain for some young people.³

Neurodivergence and sensory processing

Some trans young people are also autistic or have ADHD. Some research suggests that altered sensory processing may affect pain regulation and pain perception for some people, and that neurodivergence is an important part of how some trans young people experience pain.^3,4

Pain linked to gender affirmation

Some pain can be linked to efforts to affirm gender, or to unsafe workarounds when affirming items or care are not accessible.¹ Examples discussed in the literature include:

• Pain linked to chest binding, including back, chest, and shoulder pain³
• Pain linked to hormone injections¹
• Postural musculoskeletal pain linked to limited access to binders or other affirming supports¹

Some research suggests testosterone may reduce some pre-existing pain for some trans masculine people, while oestrogen or anti-androgen use may be linked to new onset pain for some trans feminine people.

What helps?

Chronic pain support is usually most effective when it addresses the whole picture: physical health, nervous system sensitivity, emotional well-being, daily functioning, and the young person’s environment.^2,4

Gender Affirmation

Affirming your child’s gender is more than emotional support. It may reduce stress and help them to feel safer in their body and social world. Research has found that pain can improve when a young person’s identity is affirmed socially and/or medically.³

Trauma-informed care

Effective care for trans young people with chronic pain may require addressing trauma, or at a minimum, providing trauma-informed care.¹ Trauma-informed care prioritises emotional safety, consent, collaboration, and choice.

Affirming clinical environments

Best practice recommendations emphasise providing an affirming environment and considering interactions between mental health, physical symptoms, pain treatment, community strengths, and gender affirming care.² Han and colleagues also argue that improving access to gender affirmation may reduce psychosocial distress and potentially reduce downstream impacts on chronic pain and disability.⁴

What parents and carers can do

You do not need to fix everything at once. Small, steady supports matter.

1. Take your child’s pain seriously: Let them know you believe them. Feeling dismissed can increase distress and withdrawal, which can worsen pain over time.
2. Reduce stress where you can: Look for stressors that keep your child on high alert. This might include bullying, conflict at school, misgendering, unsafe environments, or worries about healthcare access.^2,3
3. Support safe gender affirmation: If your child uses binding, tucking, packing, or other practices, support them to do this as safely as possible. If pain seems related, consider seeking advice from a clinician who is both pain-informed and trans affirming.^1,3
4. Encourage pacing: Many young people do best with pacing. That means gradual, planned steps back into movement, school, and valued activities, rather than pushing through and crashing later.
5. Prioritise sleep: Sleep and pain strongly influence each other. Supporting a consistent sleep routine is often a practical starting point.²
6. Ask for care that fits the whole person: If you can, seek a service that can address physical contributors, nervous system sensitivity, mental health, and stress. An affirming and trauma-informed approach is especially important for trans young people.^1,2

References

1. Boerner, K. E., Fox, D. A., Du, L., Metzger, D. L., Marshall, S., Moore, E. M., Narang, P., Wharton, M.-N., & Oberlander, T. F. (2025). Experiences of Gender-Diverse Youth Living With Chronic Pain. Pediatrics, 155(2),https://doi.org/10.1542/peds.2024-067035
2. Tracy, C., Lynch Milder, M., Vater, L., Lagges, A., Lemanek, K., Wrona, S., Gilbert, E., Hirsh, A. T., Miller, M. M., Donahue, K., Streicher, M., & Williams, A. E. (2024). A retrospective review of psychosocial correlates of chronic pain in cisgender, transgender, and gender-diverse youth receiving evaluation in interdisciplinary pediatric pain clinics. Canadian Journal of Pain, 8(2), 2477466.https://doi.org/10.1080/24740527.2025.2477466
3. Smith, A. M., Silvia, M., Farr, G., & Rogan, H. (2025). Expanding the Lens: Recent Developments at the Intersection of Pediatric Chronic Pain and Gender Diversity. Current Pain and Headache Reports, 29(1), 118.https://doi.org/10.1007/s11916-025-01435-7
4. Han, G. T., Basch, M., Chen, D., & Zeltzer, L. (2026). Chronic pain in transgender and gender-diverse youth: A biopsychosocial perspective. Frontiers in Pain Research, 6.https://doi.org/10.3389/fpain.2025.1709268
5. Weiss, K. E., Li, R., Chen, D., Palermo, T. M., Scheurich, J. A., & Groenewald, C. B. (2024). Sexual Orientation/Gender Identity Discrimination and Chronic Pain in Children: A National Study. American Journal of Preventive Medicine, 67(2), 175–183.https://doi.org/10.1016/j.amepre.2024.03.010