A systematic review and meta-analysis of neuropathic pain associated with coronavirus disease 2019

Background and objective: Neuropathic pain is an occasionally reported complication of coronavirus disease 2019 (COVID-19) that has received increased attention in scientific literature. In this systematic review and meta-analysis, we aimed to provide information on the frequency of neuropathic pain associated with COVID-19. Databases and data treatment: We systematically reviewed and analysed literature regarding neuropathic pain associated with COVID-19. Literature searches were conducted in PubMed, EMBASE and Cochrane Library databases. We considered prospective and retrospective studies published up until September 2022 (limitations included English language, full-text publications and studies including at least 10 patients). A random effects meta-analysis was performed and heterogeneity and publication bias were assessed. Results: We identified 149 studies. We included 17 studies in the systematic review, and six studies reporting the frequency of neuropathic pain in the acute/subacute phase of COVID-19 in the meta-analysis. The estimated frequency of neuropathic pain ranged between 0.4 and 25%. Forest plot analysis showed that the random effect overall frequency was 10% (95% confidence interval: 5%-15%), with a high level of heterogeneity (Chi2  = 104; Tau2  = 0.004; df = 5; I2  = 95%; test for overall effect: Z = 3.584; p < 0.0005). The overall risk of bias was moderate in all studies selected, particularly due to the poor description of neuropathic pain diagnostic criteria. Conclusions: The pooled estimated frequency of neuropathic pain associated with COVID-19 should be considered with caution due to the high heterogeneity across studies and the poor description of the neuropathic pain diagnostic criteria applied. Significance: Emerging evidence supports the development of neuropathic pain as a complication of COVID-19. However, longitudinal studies enrolling consecutive patients with COVID-19 that detail the diagnostic criteria for neuropathic pain are needed to better assess the frequency of this condition.