Title: The association between violence against women and chronic pain: A systematic review
and meta-analysis
Version: 3 Date: 11 Jan 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors have responded to the comments adequately. They need
to reflect further on the discussion to ensure it is fully referenced.
REQUESTED REVISIONS:
The authors have responded adequately to the issues raised. There remain some odd phrases-
that need to be edited/changed.
Please rewrite this sentence: “Studies on gender violence began many years ago, and are still
present in recent years creating a large database in which experts and researchers can find any
information to orient their study or clinical practices”
Given the authors have set up the argument, there is no need for this sentence: “The final
objective is to increase the knowledge about this condition because no one has done this complete
collection before considering it as a wide-ranging phenomenon.”
Please rewrite the sentence: “In general, it’s whatever typology of pain or discomfort in the
involved area which tends to persist for at least 3 of the past 6 months”
Please rewrite: “studies published in non-English or Italian languages” as “studies not published
in English or Italian.”
Please can you rewrite this section: “A high-quality study achieved the following criteria: cross-
sectional studies met at least 5/8 criteria, cohort studies fulfilled at least 6/11, and case-control
studies met at least 6/10 of the criteria. Low-quality studies were excluded. Cohort studies satisfy
7/11 criteria, 2 case-control studies satisfy 6/10 criteria, 2 of them satisfy 8/10  criteria, 2 of them
satisfy 7/10 criteria, and the last one satisfy 10/10 criteria, 10 cross-sectional studies satisfy 6/8
criteria, 14 of them satisfy 5/8 criteria, and the last one satisfies 8/8 criteria.” It just needs an
edit to make it comprehensible.
Please rewrite the sentence: “non-significant effect size of the overall odds ratio”
Some of the odds ratios need to be written to 2 decimal places
Please rewrite these sentences: “Healthcare workers dealing with chronic pain could treat this
type of woman without knowing it, and anti-violence workers should know that their patients
could develop pain symptoms that tend to become chronic. Without this professional integration,
the treatment of these women will never be completed and effective.” Could you in doing so, also
comment on what this means for healthcare workers? Should they screen women with chronic
pain for violence?
In the paragraph starting: “According to the bio-psycho-social model [87], we may suppose
many different factors that contribute to the onset of pain symptoms in violence victims, in…”
please could you include some references to support the argument that pain can lead to violence.
Please also clarify that pain can lead to depression or anxiety
In the discussion on no significant findings in sub-categories, please reflect on the issue that the
(non-significant) association and that violence was negatively associated: “ The subcategory of
studies that investigated only pelvic pain showed a non-significant effect size of the overall odds
ratio (OR 0.570; 95% CI, 0.25-1.29; p=0.178).” This seems contradictory to the hypothesis and
so needs touching on.
Please rewrite this into a full sentence: “Publication bias could have been a problem; therefore,
they have been investigated.”
Which subcategory for this: “There is a need for future research to better investigate this specific
subcategory.”
ADDITIONAL REQUESTS/SUGGESTIONS:
see above