Prevalence and intensity of chronic postsurgical pain after cranial surgery: a systematic review and meta-analysis of randomized and non-randomized studies

Background/Importance Estimates of chronic postsurgical pain (CPSP) after cranial surgery vary widely, and the prevalence and severity remain uncertain. Objectives To synthesize the literature and estimate the prevalence and intensity of CPSP after cranial surgery. Evidence reviews We searched MEDLINE, EMBASE, CINAHL, and Web of Science up to April 2026 for randomized and non-randomized studies reporting CPSP (pain lasting ≥3 months) after cranial surgery. We performed random-effects meta-analysis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Findings 76 studies (13 740 patients) were included. Most studies evaluated tumor resection (54 of 76; 71%), and most patients underwent craniotomy (10 813 of 13 740; 79%). The median follow-up was 28.8 months (range 3 months to 16 years). Moderate-certainty evidence from 67 studies (10 607 patients) showed the pooled prevalence of CPSP at any severity is probably 27.4% (95% CI 20.8% to 34.6%; 95% prediction interval (PI) 0% to 85.8%). Moderate-certainty evidence from six studies that reported pain intensity (233 patients) showed the average pain intensity among patients who developed CPSP is probably 5.8 (95% CI 4.6 to 7.0; 95% PI 1.79 to 9.76) on a 0–10 Numerical Rating Scale (NRS). Moderate-certainty evidence from 24 studies (4328 patients) showed the prevalence of moderate-to-severe CPSP (≥4/10 on a 0–10 NRS) is probably 16.7% (95% CI 12.8% to 20.9%; 95% PI 2.3% to 39.4%). Low-certainty evidence from 13 studies (3281 patients) suggests the prevalence of severe CPSP (≥7/10 on a 0–10 NRS) may be 5.9% (95% CI 3.0% to 9.8%; 95% PI 0% to 25.5%). Conclusions Moderate-certainty evidence suggests that CPSP probably affects approximately one in four patients after cranial surgery. Approximately one in six patients probably experience at least moderate pain (moderate certainty), and 1 in 17 may experience severe pain (low certainty). These findings underscore CPSP as a common complication after cranial surgery and highlight the need for prevention and management strategies. PROSPERO registration number CRD42024505270.