The prevalence of dysautonomia in chronic musculoskeletal pain: A systematic review and meta-analysis

Objectives

Several chronic musculoskeletal disorders are characterized by pain, fatigue, dizziness and other associated symptoms that may be related to autonomic dysfunction. The aim of this review was to estimate the prevalence of autonomic dysfunction in chronic musculoskeletal pain conditions.

Methods

MEDLINE and Embase were searched through 4 October 2024 for all peer-reviewed studies of dysautonomia in adult musculoskeletal conditions. Risk of bias was assessed using an adapted Newcastle–Ottawa Scale. The prevalence of dysautonomia and relative risk compared with healthy controls were estimated using random effects meta-analysis.

Results

A total of 17 studies (13 fibromyalgia, 3 Ehlers–Danlos syndrome, 1 rheumatoid arthritis) were identified, including 1003 participants with musculoskeletal pain and 417 healthy controls. In people with chronic musculoskeletal pain, the pooled prevalence of dysautonomia was 64% (95% CI 51, 76; I2 = 93%), more than twice as likely as healthy controls [pooled risk ratio 2.28 (95% CI 1.51, 3.45); I2 = 24%). Most studies objectively assessed the neurocardiovascular system.

Conclusion

The high prevalence of dysautonomia in patients with chronic musculoskeletal painful conditions illustrates the association between dysautonomia and chronic pain, suggesting regular screening for dysautonomia is warranted for all patients with chronic musculoskeletal pain.