Background and Aims <p>Extreme climate events may be associated with increased bodily pain, particularly among aging populations. However, individual-level evidence linking specific climate exposures to pain outcomes remains limited. This study examined the association between extreme climate exposure and pain in different body regions among middle-aged and older Chinese adults.</p> Methods <p>This study used data from the Chinese Health and Retirement Longitudinal Study (CHARLS, 2011–2020), which included 65,693 person-wave observations. Pain outcomes across the 15 body regions were self-reported. Climate exposure indices (extreme temperature, rainfall, drought, and the composite Climate Physical Risk Index [CPRI]) were derived from city-level meteorological data. Generalized additive mixed models were used to assess associations, adjusting for demographics, lifestyle, health status, cognitive function, frailty, and chronic disease.</p> Results <p>The composite CPRI was significantly associated with higher likelihood of reporting pain across most body regions (e.g., most severe neck pain, β = 0.0121). Extreme low temperatures and rainfall were significantly associated with pain in the knee, chest, and stomach. Vulnerability was significantly increased among rural residents, older adults (≥ 65 years), women, and those reporting poorer health or greater frailty. These findings remained robust in the sensitivity analyses.</p> Conclusions <p>Exposure to extreme climatic conditions is significantly associated with higher likelihood of reporting pain across multiple body regions among middle-aged and older Chinese adults. These associations are primarily immediate, suggesting that timely public health strategies might be beneficial in mitigating potential climate-related discomfort during extreme weather events. Increased vulnerability among older adults, women, rural populations, and frail individuals also highlights the need for targeted intervention strategies to mitigate climate-related health risks.</p>