title: The prevalence and moderators of clinical pain in people with schizophrenia: a systematic review and large scale meta-analysis.
abstract: BACKGROUND
  People with schizophrenia frequently have physical comorbidities that can cause pain. Experimental studies report reduced pain sensitivity among schizophrenia patients, but it remains unclear if clinically relevant pain is less prevalent in schizophrenia.
  
  
  METHODS
  We systematically searched major electronic databases from inception till 03/2014. Articles were included that reported the prevalence of clinical pain in people with schizophrenia. Two independent authors conducted searches, completed methodological quality assessment and extracted data. A random effects relative risks (RR) meta-analysis was conducted to determine the prevalence of all-cause and specific pain in schizophrenia, and the relative prevalence compared to the general population, and to assess moderators.
  
  
  RESULTS
  Altogether, 14 studies were included encompassing 242,703 individuals with schizophrenia (30.2-55.8 years) and 4,259,221 controls. Different types of pain were considered. The overall pooled prevalence of clinical pain in people with schizophrenia was 34.7% (95% CI=23.6-46.6). In the comparative analysis involving 7 studies with controls, the RR was 0.99 (95% CI=0.83-1.19). The pooled prevalence of headache among 94,043 individuals with schizophrenia was 29.9% (95% CI=3-69%) and the RR compared to 4,248,284 controls was 1.32 (95% CI=0.85-2.07). In moderator analyses, neither age, sex, study quality or pain assessment method influenced pain prevalence.
  
  
  CONCLUSIONS
  Clinical pain affects a third of people with schizophrenia and levels are similar with age- and sex-comparable controls. Future research is needed to determine if similar clinical pain prevalences in schizophrenia occur despite having more painful conditions, resulting from under-reporting, higher pain thresholds or lower help seeking behaviours.
authors.affiliation: Faculty of Education and Health, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, UK. Electronic address: b.stubbs@greenwich.ac.uk.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Department of Psycho-oncology, University of Leicester, Leicester LE1 5WW, UK. Electronic address: ajm80@le.ac.uk.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium. Electronic address: marc.de.hert@uc-kortenberg.be.
authors.forename: Marc
authors.initials: M
authors.lastname: De Hert
authors.affiliation: Zucker Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, NY 11004, USA. Electronic address: CCorrell@NSHS.edu.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Department of Physiotherapy, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: a.a.soundy@bham.ac.uk.
authors.forename: Andy
authors.initials: A
authors.lastname: Soundy
authors.affiliation: University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium. Electronic address: med.bib@uc-kortenberg.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Stroobants
authors.affiliation: University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium. Electronic address: Davy.Vancampfort@uc-kortenberg.be.
authors.forename: Davy
authors.initials: D
authors.lastname: Vancampfort
mesh_terms: D015897:Comorbidity; D006801:Humans; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology*; D015995:Prevalence; D012559:Schizophrenia / Q000453:epidemiology* / Q000503:physiopathology*
keywords: Clinical pain; Pain; Pain management; Physical health; Schizophrenia; pain assessment