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

IF 2.8 Q3 RHEUMATOLOGY

Rheumatology Advances in Practice Pub Date : 2026-03-18 eCollection Date: 2026-01-01 DOI:10.1093/rap/rkag034

Norah A Almutairi, Darren C Greenwood, Manoj Sivan

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Abstract

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; I ² = 93%), more than twice as likely as healthy controls [pooled risk ratio 2.28 (95% CI 1.51, 3.45); I ² = 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.

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慢性肌肉骨骼疼痛中自主神经异常的患病率：一项系统回顾和荟萃分析。

目的：几种慢性肌肉骨骼疾病的特征是疼痛、疲劳、头晕和其他可能与自主神经功能障碍有关的相关症状。本综述的目的是估计慢性肌肉骨骼疼痛条件下自主神经功能障碍的患病率。方法：通过MEDLINE和Embase检索到2024年10月4日的所有成人肌肉骨骼疾病自主神经异常的同行评审研究。偏倚风险采用纽卡斯尔-渥太华量表进行评估。与健康对照相比，自主神经异常的患病率和相对风险采用随机效应荟萃分析估计。结果：共纳入17项研究（13项纤维肌痛，3项ehers - danlos综合征，1项类风湿关节炎），包括1003名肌肉骨骼疼痛患者和417名健康对照。在患有慢性肌肉骨骼疼痛的人群中，自主神经异常的总患病率为64% (95% CI 51,76; i2 = 93%)，是健康对照组的两倍多[综合风险比2.28 (95% CI 1.51, 3.45)；i2 = 24%)。大多数研究客观地评估了神经心血管系统。结论：慢性肌肉骨骼疼痛患者中自主神经异常的高患病率说明了自主神经异常与慢性疼痛之间的联系，提示所有慢性肌肉骨骼疼痛患者都有必要定期筛查自主神经异常。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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