Association between pain and sarcopenia in middle-aged and older adults: a systematic review and meta-analysis.

Background: Sarcopenia 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. Methods: PubMed, 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). Results: Nine 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; Conclusion: Pain 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 Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261406169, identifier [CRD420261406169].