Accurate prediction of lubrication characteristics, specifically film thickness and pressure distribution, is pivotal for ensuring optimal performance in ball screws. Despite its significance, there is a notable dearth of studies investigating the evolution of lubrication characteristics resulted from the changing surface roughness over prolonged operation of ball screws. Furthermore, obtaining the surface roughness of ball screws poses a challenge due to the limited loading capacity of measurement instruments. Traditional methods involving cutting the screw for surface roughness measurement are impractical for continuous monitoring during extended operation. To address this issue, the present study introduces an efficient approach to model the surface roughness of the raceway in double-nut ball screws. A profilometer is employed to measure profile roughness along two directions (parallel and perpendicular to the rolling direction) without the need to cut the screw raceway. The 2D power spectral densities and height probability densities of profile roughness are calculated to model the surface roughness, and the synthesized data is utilized to solve the Reynolds equation. The simulation method is validated through friction torque tests, demonstrating a calculation accuracy exceeding 92%. The study further explores the evolution of film thickness and pressure distribution in ball screws during running-in and steady wear stages, revealing severe asperity contact in the two nuts. Additionally, variations in load ratio, friction coefficient, and film thickness ratio (λ) are investigated. Considering the load ratio and λ of the slave nut, it can be inferred that boundary lubrication persists in the two nuts throughout the operation.