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Due to the neurodegenerative nature, the diagnosis of neuropathic pain remains challenging. A grading system has been developed providing an overview of diagnostic certainty (i.e.,\n                      <jats:italic>possible<\/jats:italic>\n                      ,\n                      <jats:italic>probable<\/jats:italic>\n                      and\n                      <jats:italic>definite<\/jats:italic>\n                      ). Since no previous review has accounted for this, differences in diagnostic certainty may have affected prevalence estimates. To elucidate this issue, the current meta\u2010analysis aimed to estimate the prevalence of\n                      <jats:italic>possible, probable<\/jats:italic>\n                      and\n                      <jats:italic>definite<\/jats:italic>\n                      neuropathic pain separately, as well as the overall prevalence of neuropathic pain in MS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Databases and Data Treatment<\/jats:title>\n                    <jats:p>\n                      A comprehensive systematic literature review was conducted (by 14\u201010\u20102025) using PubMed, Embase and Scopus databases, adhering to the PRISMA guidelines. For the meta\u2010analysis, we applied the Generic Inverse Variance method, using a random\u2010effects model for proportions to compute prevalence estimates for\n                      <jats:italic>possible<\/jats:italic>\n                      ,\n                      <jats:italic>probable<\/jats:italic>\n                      and\n                      <jats:italic>definite<\/jats:italic>\n                      neuropathic pain, as well as for overall prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The literature search yielded 1638 records, of which 32 papers were considered eligible for inclusion. Disregarding diagnostic certainty, the overall prevalence of neuropathic pain in people with MS was estimated at 22.3% (95% CI: 17.3; 27.3). Following stratification by diagnostic certainty, the prevalence of\n                      <jats:italic>possible<\/jats:italic>\n                      neuropathic pain was 22.0% (95% CI: 16.0; 28.0),\n                      <jats:italic>probable<\/jats:italic>\n                      neuropathic pain was 23.7% (95% CI: 19.4; 28.0), and\n                      <jats:italic>definite<\/jats:italic>\n                      neuropathic pain was 23.4% (95% CI: 1.11; 35.8).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Neuropathic pain in MS was estimated at an overall prevalence of 22.3%. Moreover, estimates of neuropathic pain in MS across diagnostic certainty levels yielded numerically similar results. However, these findings may not provide evidence of comparability; rather, they reflect methodological heterogeneity among the included studies. As such, in line with international recommendations, a diagnosis of\n                      <jats:italic>possible<\/jats:italic>\n                      neuropathic pain appears appropriate for epidemiological purposes as well as for initial screening in pwMS. However,\n                      <jats:italic>probable<\/jats:italic>\n                      and\/or\n                      <jats:italic>definite<\/jats:italic>\n                      diagnoses should be adopted in clinical practice and in future studies investigating pain\u2010phenotype\u2010based effects in pwMS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>\n                      This review estimates the prevalence of neuropathic pain in multiple sclerosis across NeuPSIG diagnostic certainty levels, providing novel and valuable methodological insights into the application of the grading framework. Findings support the use of\n                      <jats:italic>possible<\/jats:italic>\n                      neuropathic pain for epidemiological and screening purposes, while emphasizing the importance of\n                      <jats:italic>probable<\/jats:italic>\n                      or\n                      <jats:italic>definite<\/jats:italic>\n                      diagnoses for clinical practice and pain\u2010phenotype\u2010based research. The review also highlights limitations of the framework and operationalization thereof that can inform future applications and refinements, particularly for central neuropathic pain, where diagnostic classification remains inherently challenging.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70375","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T12:55:55Z","timestamp":1788267355000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Prevalence of Neuropathic Pain in Multiple Sclerosis\u2014A Systematic Review and Meta\u2010Analysis Using the\n                    <scp>NeuPSIG<\/scp>\n                    Algorithm"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2466-4593","authenticated-orcid":false,"given":"Rasmus C.","family":"Jungersen","sequence":"first","affiliation":[{"name":"Exercise Biology, Department of Public Health Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1729-5218","authenticated-orcid":false,"given":"Victor K.","family":"Baccaro","sequence":"additional","affiliation":[{"name":"Exercise Biology, Department of Public Health Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3233-0429","authenticated-orcid":false,"given":"Lars G.","family":"Hvid","sequence":"additional","affiliation":[{"name":"Exercise Biology, Department of Public Health Aarhus University  Aarhus Denmark"},{"name":"The Danish MS Hospitals  Ry and Haslev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-2789","authenticated-orcid":false,"given":"Ulrik","family":"Dalgas","sequence":"additional","affiliation":[{"name":"Exercise Biology, Department of Public Health Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9724-767X","authenticated-orcid":false,"given":"Morten","family":"Hoegh","sequence":"additional","affiliation":[{"name":"Department of Medicine \u2013 Institute of Health Science and Technology Aalborg University  Aalborg Denmark"},{"name":"Musculoskeletal Health and Implementation Group Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2023.09.005"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2025.106691"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.29399\/npa.24802"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.105377"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.11124\/jbies\u201024\u201000523"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/pr9.0000000000001066"},{"key":"e_1_2_11_8_1","first-page":"879","volume-title":"Textbook of Pain","author":"Boivie J.","year":"1999"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458507085551"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","unstructured":"Bozhenko M. 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