Table 1 Summary of the main publications including data on pain presented in the order of citation in the manuscript

N. Ramirez/JBJS 1997 [19]

Retrospective study of 2442 patients with AIS. Mean age was 14 years for those with back pain and 13 years for those who did not have pain.

History of back pain

Back pain was reported by 23 % at the time of presentation. Of 210 patients managed with observation only and who were pain-free initially, 9 % reported back pain during follow-up (about 3 years).

Pain was associated with age >15 years or Risser sign ≥2 but not with gender, type or magnitude of the curves.

T. Sato/Eur Spine J 2011 [20]

Epidemiological study including 32,083 students without scoliosis and 51 with AIS. Age range was 9–15 years.

Questionnaire Severity of back pain defined according to functional limitation (3 categories)

Adjusted OR of back pain (point or lifetime prevalence) was 2.29 in the scoliosis group compared with the controls. Pain was also more severe, had longer duration and more recurrences in the scoliosis group.

The difference was highly significant only for pain located in the right scapular area. No difference was found for lumbar pain.

B. Lonner/Spine 2013 [21]

Prospective pretreatment multicenter and retrospective chart review including 894 patients with AIS (mean age 14.9 years) who were compared with 106 patients with Scheuermann’s kyphosis (mean age 16.1 years) and with 31 healthy adolescents (mean age 14.2 years).

SRS-22

Mean Pain scores were 4.15 in the AIS group versus 4.24 among healthy controls.

MCID for Pain was set at 0.2. Patients with Scheuermann kyphosis reported significantly more pain than AIS patients

J. Theroux/Pain Res Manag 2015 [22]

Retrospective review of a random sample of 310 charts of AIS adolescents. Mean age was 13.9 years for girls and 14.5 for boys.

Documentation of back pain from different sources. Previous surgery and other spinal pathologies were exclusion criteria.

Almost half of the patients (47.3 %) had chart-documented back pain, most frequently lumbar pain. Pain intensity was specified in only 21 % of charts and described as mild in 9.4 %, moderate in 11 % and severe in 1 % of cases. Pain intensity was not correlated with the Cobb angle.

No comparison group.

D.W. Roberts/Spine 2011 [23]

Longitudinal cohort study comparing outcomes before and after surgery. N = 744 patients. Mean age was 15.2 years for boys and 14.0 in girls.

SRS-30

Preoperatively Pain scores were 4.1 for females and 4.3 for males. Of note, the latter were 1.2 years older than females (average age 15.2 versus 14.0 years).

Despite boys were significantly older, the baseline differences between genders were N.S.

A.J. Boniello/J Neurosurg Spine 2015 [24]

Meta-analysis of preoperative data limited to patients with Lenke type 1C curves. 1 prospective and 6 retrospective case-control studies. Overall 488 patients. Mean age for each group: 14.7 and 14.8 years (N.S.).

SRS-22

Baseline data from the largest multicenter study showed Pain scores of 4.13 ± 0.77 in the group eventually undergoing selective fusion Vs 3.92 ± 0.79 in those later fused nonselectively.

J. Bago/Eur Spine J 2009 [25]

Study designed to identify Minimal important differences in 91 AIS patients undergoing surgical procedures. Mean age was 18.1 years (range 10–38 years).

SRS-22

Preop scores were 3.8–3.9

MID for Pain dimensions was identified at 0.6

L.Y. Carreon/Spine 2010 [26]

Longitudinal cohort (735 girls & 152 boys. Mean age 14.3 years) to evaluate MCID

SRS-22 & SRS-30

Baseline scores for Pain: 4.1 ± 0.71

MCID for Pain domain: 0.2

K. Verma/Spine 2010 [27]

Healthy adolescents. Anonymous survey N = 450 / 16 (10–22) years

SRS-22

Mean score for Pain domain was 4.3 ± 0.6. Males had higher score. African Americans scored higher than Hispanics.

Normative baseline in healthy adolescents

L.J. Morse/Spine 2012 [28]

Preoperative comparison of 6 ethnic groups of children with AIS. Total = 1853 composed of US white (1234), black (213), Hispanic (78), and Asian (29), as well as native Japanese (192) and Koreans (107). Overall mean age was 14.85 years ranging from 14.34 (Hispanics) to 14.97 (white). There were statistically significant differences between groups in terms of age, gender, BMI, and major curve magnitude.

SRS-30

The scores for the Pain domain ranged from 4.52 ± 0.51 among the Japanese patients, to 4.04 ± 0.72 in the US white patients (P < 0.001).

Whites reported more pain than Japanese and Koreans. The authors recommend taken into account cultural and ethnic differences when counseling patients.

K. Watanabe/Spine 2007 [29]

Comparison of 2 groups of 100 AIS patients each, one American and the other Japanese. Both groups were comparable with regard to age (mean age was 15.0 years in Americans and 14.9 years in Japanese), gender, curve location, Cobb angle and thoracic kyphosis.

SRS-24

Scores for the total pain domain were 3.7 ± 0.8 among Americans and 4.3 ± 0.4 in the Japanese group

The authors highlight the cultural differences and suggest that a cross-cultural comparison of the SRS-24 content is necessary.

E. Misterka/Med Sci Monit 2012 [30]

Retrospective study comparing 20 rural and 40 urban Female Polish patients with AIS with ≥ 2 years follow-up after surgery for AIS

SRS-24

Mean Pain scores were 4.4 in the urban group and 4.3 in the rural one (NS).

Some differences between groups were found but the authors did not end-up with strong conclusions based on the environment.

J.A. Lerman/Spine 2002 [32]

102 adolescents with AIS (15.3 years), 47 with congenital scoliosis and 84 “normals”.

PODCI (Pediatric Outcomes Data Collection Instrument). All dimensions scaled 0–100 where highest is best.

Comfort/Pain scores self reported by adolescents (N = 95) (parents’ questionnaires NOT included here) respectively were 86.7 ± 14.5 for “Normals” and 75.2 ± 22.4 in the AIS group (P < 0.05)

No significant differences in Comfort/pain scores according to age, Cobb angle or curve location.

R.J. Haynes/J Pediatr Orthop 2001 [33]

Only the 1st administration of the questionnaire included. Parents’ questionnaire for patients 2–18 years. Patients’ questionnaire for those aged 11–18 years.

POSNA (Pediatric Orthopaedic Society of North America)

L.N. Pellegrino/J Spinal Disord Tech 2014 [37]

Prospective observational study pre- and postoperative of 33 patients (mean age 15.6 years).

SRS-30 and SF-36

Preop mean SRS pain score was 3.95 ± 0.09 and SF-36 61.00 ± 4.20

P.R.P. Rushton/Spine 2013 [55]

Review and statistical analysis of the literature. Data on pain were available from 21 cohorts from 15 published studies.

SRS-22r

In 17 cohorts AIS patients reported statistically more pain than controls, in 3 cohorts patients and controls scored similarly, and in 1 study patients had less pain. However, in only 1 study was the difference clinically relevant (>MCID)

E.M. Clark/Spine 2016 [36]

Prospective, population-based, birth cohort study. Subjects with spinal curve ≥ 6° at the age 15 (N = 202/3184) were surveyed for back pain at age 18

1^ary outcome: Pain (≥1 day in the prev. month).

At age 15 202 subjects had spinal curves ≥6°. Median curve size 11°. Curves ≥25° were found in 11 participants.

Spinal curves were identified using the DXA scoliosis method.

2^ary outcomes: Self-reported days off activities

Back pain was reported by 21.3 % of the subjects with curves versus 16 % of those without.

≥7 days off activities in the last 6 months were reported by 21.7 % of those with spinal curves versus 12.3 % of the controls.