Chronic pain after 40 can become more noticeable as our bodies change with age, and for women, perimenopause and menopause may add another layer. Hormonal changes can influence muscles, joints, sleep, mood, and the way pain is experienced, but menopause is rarely the only cause. Previous injuries, arthritis, reduced muscle strength, poor sleep, stress, metabolic health, and inflammation may all contribute. CBD is being studied for chronic pain, but current evidence remains mixed, and it has not been proven to treat menopause-related pain or chronic inflammation. Understanding why you hurt is the first step toward deciding what may actually help.

Why Does Everything Seem to Hurt More After 40?

One of the questions I hear from patients as they move through their 40s and 50s is some version of, “Doc, why does everything seem to hurt now?” Maybe your knees feel different after a long walk. Your lower back is stiff when you get out of bed. Your shoulders stay sore longer after a workout. An old injury that barely bothered you for years suddenly starts reminding you that it is still there.

For women, these changes may happen at the same time as perimenopause or menopause. That can make it tempting to blame every new ache on hormones. The reality is more complicated.

A recent review of pain during menopause describes musculoskeletal discomfort, joint stiffness, headaches or migraines, and vulvovaginal pain as issues that can occur during the menopause transition. Researchers also point to hormonal fluctuations, sleep disturbance, stress, mood, genetics, and psychosocial factors as contributors to the pain experience. PubMed

At the same time, your body has accumulated decades of activity. Previous sports injuries, repetitive work, pregnancies, arthritis, changes in body composition, reduced muscle strength, poor sleep, stress, and other health conditions don’t disappear simply because menopause begins.

That is why I don’t like telling someone that pain is “just age” or “just menopause.” Chronic pain after 40 deserves a better explanation.

Pearls

• Menopause may influence how the body experiences pain, but hormones are only one part of a much larger picture.
• An injury that occurred years ago can become more noticeable later as strength, mobility, activity level, and joint health change.

What Is Chronic Pain?

Pain is normally protective. Touch a hot surface and pain tells you to pull your hand away. Sprain an ankle and pain reminds you that the tissue needs time to recover. That type of pain has a useful biological purpose.

Chronic pain is different. It persists or repeatedly returns beyond the normal period of healing and can become a health problem of its own. In research, chronic pain is commonly defined using time periods of approximately three months or longer, although the exact definition can depend on the condition being studied.

Chronic pain can present in many ways. Some people describe an aching or throbbing sensation. Others experience burning, shooting, tingling, stiffness, tenderness, or sensitivity to touch. It may be localized to one joint or region, such as the knee or lower back, or involve several parts of the body.

Pain can also progress beyond the physical sensation itself. When it interferes with sleep, exercise, work, relationships, travel, or everyday activities, its impact becomes much larger. The National Center for Health Statistics calls pain that frequently limits life or work activities high-impact chronic pain. In 2023, 24.3% of U.S. adults reported chronic pain and 8.5% reported high-impact chronic pain. CDC

I think that distinction matters. When I evaluate someone with pain, I don’t only want to know whether the pain is a six or an eight. I want to know what the pain has taken away. Can you still exercise? Can you sleep? Can you work comfortably? Can you walk through an airport, play with your children or grandchildren, or enjoy a vacation?

Those answers often tell me more about the real impact of chronic pain than a number alone.

Pearls

• Chronic pain is not simply pain that “hurts a lot.” Duration and the effect on everyday function are important parts of the picture.
• High-impact chronic pain specifically describes chronic pain that frequently restricts a person’s life or work activities.

How Chronic Pain Presents and How It Is Diagnosed

There is no single blood test, scan, or X-ray that diagnoses every form of chronic pain. Diagnosis begins with the story.

I want to know where the pain started, how long it has been present, what makes it better or worse, whether an injury occurred, and whether there is stiffness, weakness, swelling, numbness, tingling, fatigue, or sleep disruption. I also want to know how the pain affects daily life.

The physical examination then helps narrow down the possibilities. Depending on the symptoms, imaging such as X-rays, ultrasound, CT, or MRI may be appropriate. Blood testing may be useful when inflammatory, autoimmune, metabolic, nutritional, or other medical conditions are suspected.

The important point is that chronic pain is not one disease. Osteoarthritis, rheumatoid arthritis, degenerative spine disease, neuropathy, fibromyalgia, migraine, tendon injuries, muscle disorders, and nerve compression can all produce chronic pain, but they don’t necessarily require the same treatment.

That becomes especially important after 40. A woman experiencing hip pain during perimenopause may have hormone-related changes influencing her pain experience, but she may also have osteoarthritis, tendinopathy, a previous injury, or pain referred from the lower back.

The type of pain also gives us important clues. Burning, tingling, pins-and-needles sensations, or numbness can suggest nerve involvement rather than ordinary muscle soreness. If that sounds familiar, I recommend reading my article CBD for Neuropathy: Gummies, Tinctures or Topicals for Nerve Pain?, where I explain how neuropathy presents, what can cause it, and why identifying the underlying nerve problem matters before choosing a treatment or CBD product.

Pearls

• Chronic pain is usually diagnosed by combining the patient’s history, physical examination, functional limitations, and appropriate testing—not by one test alone.
• Burning, numbness, and tingling may point toward nerve involvement, while swelling, stiffness, weakness, or mechanical pain may suggest a different process.

Who Is Most Affected by Chronic Pain After 40?

According to 2023 data from the CDC’s National Center for Health Statistics, 25.4% of women reported chronic pain compared with 23.2% of men. Women were also more likely to report high-impact chronic pain: 9.6% compared with 7.3% of men. Chronic pain increased with age. CDC

There are important racial and geographic differences as well. In the same national survey, chronic pain was reported by 30.7% of non-Hispanic American Indian and Alaska Native adults, 28.0% of non-Hispanic White adults, 21.7% of non-Hispanic Black adults, 17.1% of Hispanic adults, and 11.8% of non-Hispanic Asian adults. These statistics describe population patterns; they don’t tell us that race itself causes pain. Access to healthcare, occupation, income, geography, environmental factors, underlying disease, stress, and other social determinants may all influence those differences. CDC

Geography matters too. The CDC’s analysis of chronic pain by sex and urbanization found that chronic pain generally became more common as communities became less urban.

For women in midlife, menopause adds another consideration. A 2026 review of chronic pain at midlife describes chronic pain as disproportionately affecting women and explains how hormonal changes may interact with musculoskeletal degeneration, sleep problems, mood, neuroimmune mechanisms, and social factors.

That is why I prefer to look at the whole person instead of reducing pain to age, gender, race, or hormones.

Pearls

• Women reported both chronic pain and high-impact chronic pain more often than men in the 2023 National Health Interview Survey. 
• Where someone lives can matter: national data show chronic pain becomes more common as urbanization decreases. 

Menopause, Inflammation and Pain: What’s the Connection?

Inflammation has become one of the most overused words in wellness. Almost every symptom seems to get blamed on it, and almost every supplement seems to promise to eliminate it. The truth is more interesting.

Inflammation is a normal part of the body’s immune and repair system. If you injure a muscle or fight an infection, inflammatory signaling is part of how your body responds. Chronic inflammation is different. Long-term inflammatory activity can accompany conditions such as autoimmune disease, metabolic disorders, and certain forms of arthritis.

Pain and inflammation are related, but they aren’t interchangeable. You can have pain without significant systemic inflammation, and inflammation can exist before someone notices pain.

Menopause adds another layer. Estrogen interacts with bone, muscle, connective tissue, and nervous-system pathways involved in pain. The clinical review on pain during menopause describes fluctuations in estrogen and progesterone as important contributors to musculoskeletal pain and joint stiffness, while also emphasizing that sleep, stress, mood, genetics, and psychosocial factors contribute to the experience.

Sleep is a good example. Hot flashes or other menopause symptoms may interrupt sleep. Poor sleep can make pain harder to tolerate. Pain then makes it harder to sleep, which can create a cycle of discomfort, fatigue, reduced activity, and poorer recovery.

Understanding those connections gives us more opportunities to intervene than simply trying to “fight inflammation.”

Pearls

• Inflammation is not inherently bad; short-term inflammation is an essential part of normal immune defense and tissue repair.
• Improving sleep may indirectly improve someone’s experience of pain even when sleep itself wasn’t the original cause of the pain.

Traditional Treatments for Chronic Pain

Traditional pain treatment depends on the diagnosis. There is no single medication or procedure that makes sense for every person with chronic pain.

Common approaches may include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), topical medications, certain antidepressant or anticonvulsant medications for neuropathic pain, physical therapy, injections, and condition-specific treatments. In selected cases, surgery may be appropriate.

The advantage of traditional treatment is that many therapies have been studied extensively, and treatment can be matched to a specific diagnosis. Physical therapy can address strength and movement problems. Anti-inflammatory medications may be appropriate for certain conditions. Neuropathic medications target different pathways than standard pain relievers.

The disadvantage is that every treatment has limitations. NSAIDs can create gastrointestinal, kidney, cardiovascular, or bleeding concerns in some patients. Some nerve-pain medications can cause sedation or dizziness. Opioids carry important risks, particularly with longer-term use. Procedures and surgery have their own risks and aren’t appropriate for every diagnosis.

For women going through menopause, hormone therapy may also enter the conversation when significant menopause symptoms are present. But hormone therapy shouldn’t automatically be treated as a chronic-pain medication simply because pain appeared during menopause.

This is why individualized care matters. The question isn’t simply, “What can I take for pain?” The better question is, “What is causing my pain, and which treatment offers the best balance of benefit and risk for me?”

Pearls

• Different types of pain respond to different treatments; nerve pain, inflammatory pain, and mechanical joint pain should not automatically be managed the same way.
• A medication can be effective and still be inappropriate for a particular patient because of kidney, liver, cardiovascular, gastrointestinal, medication-interaction, or other risks.

Holistic Treatments: Looking Beyond Medication

Holistic care doesn’t mean rejecting traditional medicine. To me, it means looking at the entire person rather than treating only the painful body part.

Movement is one of the most important pieces. Depending on the diagnosis, walking, resistance training, mobility work, aquatic exercise, yoga, or condition-specific rehabilitation may help maintain function. An AHRQ systematic review of non-drug treatments for chronic pain found that exercise, multidisciplinary rehabilitation, cognitive behavioral therapy, acupuncture, and mind-body practices produced durable small-to-moderate improvements in pain or function for certain chronic pain conditions. Effective Healthcare

Nutrition matters too, but I prefer realistic advice over “anti-inflammatory miracle diets.” A balanced diet built around vegetables, fruits, adequate protein, fiber, healthy fats, and minimally processed foods supports overall health and can help with weight and metabolic health when those factors contribute to joint stress.

Sleep deserves just as much attention. So does stress. If pain is keeping you awake, or poor sleep is making your pain more difficult to manage, treating only the painful joint may leave half of the problem untouched.

The biggest advantage of these approaches is that they can improve more than pain. Strength training can support mobility and independence. Better sleep can improve energy and mood. Stress management may improve quality of life.

The downside is that holistic strategies require consistency. They aren’t instant fixes, and they still need to be appropriate for the underlying diagnosis.

Sometimes staying active becomes difficult because the pain starts at the foundation, your feet. Plantar fasciitis, arthritis, flat feet, tendon problems, nerve compression, and other foot conditions can change the way you walk and eventually affect your knees, hips, and back. If every step has started feeling different, I recommend reading When Every Step Hurts: Common Foot Conditions & CBD. In that article, I explain why foot pain shouldn’t simply be accepted as part of getting older and how protecting mobility becomes increasingly important for active longevity.

Pearls

• Holistic care and conventional medicine don’t have to compete. They often work best when they’re used together.
• For chronic pain, improvement in function, walking farther, sleeping better, exercising again, can be just as meaningful as a change in the pain score.

CBD and Cannabis for Chronic Pain After 40

This is where CBD enters the conversation, but I want to separate the research from the marketing.

CBD, or cannabidiol, is one of the major cannabinoids found in cannabis. Unlike THC, CBD doesn’t generally produce the classic intoxicating cannabis high. Both interact with biological systems involved in pain and other functions, but they don’t act identically.

A systematic review published in Pain Management Nursing evaluated research on CBD for chronic pain and found encouraging results in several studies. However, the authors also identified major differences in study design, CBD formulations, populations, and outcome measurements and concluded that stronger research is still needed. PubMed

A separate 2024 systematic review of clinical and preclinical CBD pain research also found potentially promising findings while emphasizing limitations in the clinical evidence. PubMed

So when a patient asks me, “Does CBD work for chronic pain?” my answer isn’t a simple yes or no.

I think the evidence is interesting enough to continue studying, and some adults incorporate CBD into their wellness and recovery routines. But I won’t tell you that CBD cures chronic pain, reverses arthritis, or eliminates menopause-related inflammation. The research doesn’t support those promises.

That distinction is important to me as a physician and as someone who spent years playing professional football. I understand why people with aching joints and old injuries look for alternatives. My approach is to use cannabinoids thoughtfully, alongside movement, recovery, sleep, good medical care, and an understanding of what is actually causing the pain.

If you’re new to cannabinoids, my CBD wellness guide provides a broader introduction to CBD and how I approach it in everyday wellness.

Another question I hear frequently is whether CBD or THC makes more sense for pain. They’re both cannabinoids, but they’re not interchangeable. THC is intoxicating, while CBD generally doesn’t produce the traditional cannabis high, and the clinical evidence differs depending on the cannabinoid, formulation, and type of pain being studied. I break those differences down more thoroughly in CBD vs. THC for Pain: What’s the Difference?. If you’re considering cannabinoids specifically because of chronic pain, I recommend reading that article before assuming that CBD and THC will produce the same experience.

Pearls

• CBD has legitimate scientific research behind it, but promising evidence is different from proof that it treats a specific disease.
• THC and CBD are both cannabinoids, but THC is intoxicating while CBD generally does not produce the same classic high.

Routes of Administration: Gummies, Tinctures, Softgels, Topicals and Inhalation

How you take a cannabinoid matters almost as much as what cannabinoid you take.

Tinctures and oils provide a liquid format and allow the amount used to be adjusted more easily than a premeasured gummy. When held under the tongue, some absorption may occur through the oral tissues, while the portion that is swallowed continues through the digestive system. My Pure CBD Tincture is one option for adults who prefer this type of routine.

Capsules and softgels offer consistency and convenience. They’re easy to incorporate into a daily routine and avoid the taste of a tincture. My Full Spectrum CBD Softgels provide this type of format. The tradeoff is that oral products pass through digestion, so their effects aren’t as quickly adjustable as an inhaled product.

Gummies are convenient, portable, and premeasured. For people specifically looking to avoid THC, my CBD Isolate Gummies provide a THC-free option. Oral cannabinoid absorption can vary between individuals and can also be affected by food, formulation, metabolism, and medications.

Topicals are especially relevant to this article because many adults over 40 aren’t necessarily looking for a whole-body cannabinoid experience. They may want something they can incorporate into a massage or a post-activity routine. My CBD Sports Cream, CBD Body Rub, and CBD Body Oil can fit naturally into body-care and recovery routines.

Smoking and vaping deliver cannabinoids through the lungs and generally act more rapidly than swallowed products. However, inhalation introduces respiratory and product-quality considerations, which is why I don’t automatically consider the fastest route the best route.

There isn’t one universally superior CBD format. The best route depends on your goal, medications, health history, preference, and whether THC is appropriate for you.

Pearls

• The same cannabinoid can feel different depending on whether it is inhaled, swallowed, used as a tincture, or applied topically.
• A higher milligram number doesn’t automatically make a product more appropriate; route, formulation, consistency, and individual response matter too.

Rolling It All Up

Chronic pain after 40 is rarely about one thing. For women, menopause can be part of the story, but so can previous injuries, arthritis, changes in muscle strength, sleep, stress, activity, metabolic health, and the normal wear that comes with living an active life.

That’s why my first recommendation isn’t to chase inflammation or immediately reach for CBD. Find out why you hurt. Understand the condition. Look at what the pain is preventing you from doing. Then build a plan that may include traditional treatment, movement, strength, nutrition, sleep, stress management, physical therapy, and other appropriate therapies.

CBD and cannabis may have a place in that conversation for some adults. Research into CBD and chronic pain is active and some findings are encouraging, but we still need better clinical evidence. If you decide to incorporate CBD into your wellness routine, choose the route that makes sense for your goals and always consider medications, side effects, THC exposure, and your individual health history.

Before taking CBD, cannabis, or any new supplement, consult with a qualified healthcare professional, particularly if you take prescription medications or have an underlying medical condition.

If you decide CBD is appropriate for you, you can explore the CBD and cannabinoid products I created for Dr. Damas Wellness. My goal in creating these products has always been to offer trusted, thoughtfully formulated options that fit into a responsible wellness routine. No product replaces appropriate medical care, but the right wellness tools can become part of a much bigger strategy for moving, recovering, resting, and feeling your best.

If you’d like to continue learning, visit the Dr. Damas Knowledge Center, where I share physician-written education about CBD, cannabis, pain, sleep, recovery, and holistic wellness. You can also learn more about me, Dr. Hervé Damas, read more About Dr. Damas Wellness, or contact us with your questions. We’re always happy to hear from you.

And if you know someone over 40 who has started wondering why her body suddenly feels different, share this article with her. Good health information becomes more valuable when we pass it along.

Pearls

• The goal isn’t simply to eliminate every sensation of pain; it’s to preserve movement, independence, sleep, confidence, and quality of life.
• The best chronic-pain plan is usually not one product or treatment. It’s a personalized combination of appropriate medical care, movement, recovery, lifestyle, and informed choices.