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Prevalence of chronic pain after spinal cord injury: a systematic review and meta-analysis
  1. Christine Hunt1,
  2. Rajat Moman2,
  3. Ashley Peterson2,
  4. Rachel Wilson3,
  5. Stephen Covington3,
  6. Rafid Mustafa4,
  7. M Hassan Murad5 and
  8. W Michael Hooten1
  1. 1 Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Neurology, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Preventive Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Christine Hunt, Anesthesiology-Pain Medicine, Mayo Clinic, Rochester, MN 55905, USA; Hunt.christine{at}


Background The reported prevalence of chronic pain after spinal cord injury (SCI) varies widely due, in part, to differences in the taxonomy of chronic pain. A widely used classification system is available to describe subcategories of chronic pain in SCI, but the prevalence of chronic pain in SCI based on this system is unknown.

Objective The primary objective of this systematic review and meta-analysis is to determine the prevalence of chronic pain after SCI based on the International Spinal Cord Injury Pain (ISCIP) classification system.

Evidence review A comprehensive search of databases from January 1980 to August 2019 was conducted. The risk of bias was assessed using a modified tool developed for uncontrolled studies. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess certainty in prevalence estimates.

Findings A total of 1305 records were screened, and 37 studies met inclusion criteria. The pooled prevalence of overall chronic pain was 68% (95% CI 63% to 73%). The pooled prevalence of neuropathic pain in 13 studies was 58% (95% CI 49% to 68%); the pooled prevalence of musculoskeletal pain in 11 studies was 56% (95% CI 41% to 70%); the pooled prevalence of visceral pain in 8 studies was 20% (95% CI 11% to 29%) and the pooled prevalence of nociceptive pain in 2 studies was 45% (95% CI 13% to 78%). Meta-regression of risk of bias (p=0.20), traumatic versus non-traumatic etiology of injury (p=0.59), and studies where pain was a primary outcome (p=0.32) demonstrated that these factors were not significant moderators of heterogeneity. Certainty in prevalence estimates was judged to be low due to unexplained heterogeneity.

Conclusion This systematic review and meta-analysis extends the findings of previous studies by reporting the prevalence of chronic pain after SCI based on the ISCIP classification system, thereby reducing clinical heterogeneity in the reporting of pain prevalence related to SCI.

  • chronic pain
  • epidemiology
  • neuralgia

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  • Contributors All authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; and have participated in drafting the work or revising it critically for important intellectual content. All have submitted final approval of the version published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.