A multivariate meta-analysis on the relationship between social connectedness and pain

Background Social disconnection has emerged as a major public health concern, with health risks comparable to established biomedical factors. At the same time, pain remains the leading cause of years lived with disability worldwide, imposing profound individual and societal costs. Although social factors are increasingly implicated in pain perception and chronification, existing evidence is fragmented across heterogeneous and often conflated constructs of social connectedness. It remains unclear whether subjective experiences such as loneliness or structural factors such as social isolation differentially relate to pain outcomes. A comprehensive synthesis directly comparing these dimensions has been lacking. Methods We conducted a preregistered multivariate meta-analysis (PROSPERO: CRD420250643896) including 239 studies, 520 effect sizes, and 1,407,803 participants from clinical and non-clinical populations. Pain outcomes encompassed sensory, affective, cognitive, and functional domains. Social connectedness was operationalized as loneliness, social isolation, social support, and social exclusion. Multilevel random-effects models accounted for within-study dependency, with extensive sensitivity analyses and correction for small-study bias. Results Across populations and social outcomes, greater social connectedness was associated with lower pain (z = -0.09, 95% CI -0.11 to -0.07). Notably, loneliness emerged as the strongest correlate (z = 0.14, 95% CI 0.11 to 0.17). Associations with social isolation were smaller compared to loneliness but were also significant (z = 0.09, 95% CI 0.05 to 0.13). Social support showed modest, significant inverse associations (z = -0.05, 95% CI -0.08 to -0.03), primarily confined to affective and somatic pain components. No reliable association was observed for social exclusion. Associations were consistent across age, sex, and clinical status, and longitudinal evidence supported temporal links between changes in social connectedness and subsequent pain outcomes. Conclusions This large-scale synthesis identifies subjective social disconnection, particularly loneliness, as a robust correlate of pain across populations and pain dimensions, exceeding the relevance of objective social isolation. Given evidence linking loneliness to increased analgesic and psychotropic medication use, social disconnection may contribute to pharmacological burden and polypharmacy risk in vulnerable populations. Social connectedness emerges as a clinically meaningful, non-pharmacological determinant of pain and a potential target for integrative pain prevention and management strategies.