Puberty as a risk contributor to chronic pain: A systematic review and meta-analysis of observational studies

Emina Cholich

Background: Sex differences in pain have led to the hypothesis that chronic pain (CP) and related physical and mental illness are linked with puberty. Inconsistent methodology and paucity of longitudinal research continues to obscure causal conclusions, hindering the applicability and potential relevance of the observed trends in informing clinical practice guidelines. Objectives: (1) Examine the quality of observational studies evaluating the puberty-CP relationship; (2) Determine the strength of the association between advancing pubertal development/stage (PD) and pubertal timing (PT) and pain; (3) Examine sex differences in the puberty-CP relationship; (4) Explore effect of negative affectivity on the puberty-CP relationship. Data Source: Published English, or translated to English, articles from 2000-2019; PROQUEST Central, PsychARTICLES, Scopus, Pubmed, Science Direct, and WebofScience using: “puberty”, “pubertal”, “progression”, “pubertal stage”, “pubertal development”, “pubertal timing”, “menarche”, “chronic pain”, “pain”, “paediatric chronic pain”, “pediatric”, “musculoskeletal”, “back pain”, “headache” and “widespread”. Study Selection: Seventeen eligible studies evaluating the puberty-CP relationship were assessed for quality (STROBE) and risk of bias prior to inclusion in the meta-analyses. Data Analysis: Analyses were conducted in CMA-V3 to evaluate the advancing PD, PT, and CP relationship. Outcome data on PD-CP were stratified by sex. Analyses of PT-CP were conducted at the subgroup level (early, normative, late). Sources of heterogeneity were explored, and sensitivity analyses were conducted. All results were reported in ORs and 95% CIs. Findings: Early PT had the strongest association with CP pathology, CP and related symptoms increased with advancing PD, and negative affectivity had a moderating effect on both relationships. Females were more impacted than males on all accounts. Limitations: Heterogeneity levels were high, and we did not have enough studies or overall power to conduct meta-regression analyses of variables suspected to contribute to the heterogeneity. Significant time constraints prohibited the researchers from contacting authors for required raw data from individual studies.

Puberty as a risk contributor to chronic pain: A systematic review and meta-analysis of observational studies

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