title: The prevalence of pain in bipolar disorder: a systematic review and large-scale meta-analysis.
abstract: OBJECTIVE
  To conduct a meta-analysis investigating the prevalence of pain in people with bipolar disorder (BD).
  
  
  METHODS
  A systematic review and random effects meta-analysis searching major electronic databases from inception till 01/2014 in accordance with the PRISMA statement. We included articles reporting quantitative data on the prevalence of pain in people with BD with or without a healthy control group. Two independent authors conducted searches, extracted data, and completed methodological quality assessment.
  
  
  RESULTS
  Twenty two cross-sectional studies were included, representing 12,375,644 individuals (BD n=171,352, n controls=12,204,292). The prevalence of pain in people with BD was 28.9% (95% CI=16.4-43.4%, BD n=171,352). The relative risk (RR) of pain in BD compared to controls was 2.14 (95% CI=1.67-2.75%, n=12,342,577). The prevalence of migraine was 14.2% (95% CI=10.6-18.3%, BD n=127,905), and the RR was 3.30 (95% CI=2.27-4.80%, n=6,732,220).About 23.7% (95% CI=13.1-36.3%, n=106,214) of people with BD experienced chronic pain. Age, percentage of males, methodological quality, and method of BD classification did not explain the observed heterogeneity.
  
  
  CONCLUSIONS
  People with BD experience significantly increased levels of pain (particularly chronic pain and migraine). The assessment and treatment of pain should form an integral part of the management of BD.
authors.affiliation: Department of Health and Social Care, Greenwich, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stubbs
authors.forename: L
authors.initials: L
authors.lastname: Eggermont
authors.forename: A J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: M
authors.initials: M
authors.lastname: De Hert
authors.forename: C U
authors.initials: CU
authors.lastname: Correll
authors.forename: A
authors.initials: A
authors.lastname: Soundy
authors.forename: S
authors.initials: S
authors.lastname: Rosenbaum
authors.forename: D
authors.initials: D
authors.lastname: Vancampfort
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000150:complications / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000209:etiology; D010146:Pain / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012737:Sex Factors; D055815:Young Adult
keywords: bipolar disorder; chronic pain; migraine; pain; severe mental illness