Paediatric chronic pain prevalence in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND: Chronic pain is a leading cause of morbidity in children and adolescents globally, with a significant impact on quality of life. This is the first systematic review and meta-analysis on paediatric chronic pain in low- and middle-income countries (LMICs). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE (via PubMed), Embase, CINAHL, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, and the WHO Global Index Medicus for all studies published prior to January 7, 2022. Articles published in all languages that included populations age 19 years and under living in LMICs were considered. Chronic pain was defined as persistent or recurrent pain that is present for ≥3 months, per the International Classification of Diseases (ICD-11) definition. Summary data were extracted from published reports and evaluated with mixed-effects regression analysis. PROSPERO Record ID: CRD42021227967. FINDINGS: Of the 2875 studies identified, 70 articles were reviewed, with 27 studies representing 20 LMICs eligible for analysis. The average prevalence for each pain type reported with 95% confidence interval is as follows: general/multi-site/any 20% (16–25), musculoskeletal (MSK) pain 9% (7–13), abdominal pain 7% (5–10), headache 4% (2–10), and fibromyalgia per American College of Rheumatology or Yunus and Masi criteria 3% (1–10). Overall, a pooled mean of 8% chronic pain was estimated across all studies. A significantly high level of heterogeneity was found across all studies (I(2) >90%). Chronic headache (OR=1·65, 95% CI 1·39–1·96), abdominal pain (OR=1·36, 95% CI 1·22–1·51), and generalized/multi-site pain (OR=1·54, 95% CI 1·31–1·81) were significantly more prevalent in females than males. INTERPRETATION: The characterization of paediatric chronic pain in low- and middle-income countries suffers from a paucity of data and significant heterogeneity in the assessment methods. Understanding the global burden of chronic pain in this group should be prioritized. FUNDING: None.