2. Pain as reported in individual trials.
| Study ID | Device type | Pain outcome parameter | Pain during first 24 hours | Pain during the first 7 days | Pain on device removal | Pain during erection |
| Huo 2015 | Crush | VAS (mean, SD) | Mean score: 1.9 (SD 1.3) with device vs 5.2 (SD 1.7) with surgery; P < 0.01 | Not reported | Not applicable | Not reported |
| Jin 2015 | Crush | VAS (mean, SD) | Mean intraoperative pain score: 0.8 (SD 0.5) with device vs 2.4 (SD 0.8) with surgery; P < 0.001 Mean 1‐hour postoperative pain scores: 4.0 (SD 0.9) with device vs 5.8 (SD 1.0) with surgery; P < 0.001 |
Not reported | Not applicable | Not reported |
| Kanyago 2013 | Crush | VAS (median, IQR) | Median pain score: 1/10 (IQR 0–4) with device vs 3/10 (IQR 2–5) with surgery; P = 0.01 | Pain‐free at 3 days: 69.9% with device vs 62.7% with surgery; RR 1.11, 95% CI 0.87 to 1.43; P = 0.5. All participants in both groups were pain free at 7 days | Not reported | Not reported |
| Lagarde 2009 | Crush | VAS (mean pain score [0–10]) | Not reported | As‐treated analyses results: mean pain score at postoperative day 3: 9.5 with TK vs 6.1 with FG; P = 0.003 | Not applicable | Not reported |
| Li 2010 | Crush | VAS (mean, SD) | Mean intraoperative pain score: 0.21 (SD 0.65) with SR vs 3.72 (SD 1.45) with surgery Mean pain score at 24 hours: 1.83 (SD 0.86) with SR vs 5.27 (SD 1.74) with surgery |
Not reported | Not applicable | Not reported |
| Li 2014 | Crush | VAS (mean, SD) | Mean intraoperative pain score: 0.81 (SD 0.81) with for DCSD vs 2.42 (SD 1.15) with surgery; P < 0.05 Mean pain score at 24 hours: 1.84 (SD 1.02) with DCSD vs 4.99 (SD 1.36) with surgery; P < 0.05 |
Not reported | Not applicable | Not reported |
| Lv 2014 | Crush | VAS (mean, SD) | Mean intraoperative pain score: 1.9 (SD 1.3) with DCSD vs 5.8 (SD 2.1) with SR vs 6.2 (2.2) with surgery. Pain scores using DCSD was significantly lower than both SR and surgical circumcision; P < 0.001 | Pain scores at 1 week: 2.7 (SD 0.9) with DCSD vs 6.4 (SD 2.0) with SR vs 3.3 (SD 0.8) with surgery; P < 0.001 | Not reported for SR. Not applicable for DCSD | Not reported |
| Miao 2015 | Crush | VAS (mean, SD) | Mean intraoperative pain score: 1.37 (SD 0.68) with DCSD vs 1.20 (SD 0.79) with foreskin cerclage vs 3.06 (SD 0.75) with surgery. Pain scores using foreskin cerclage were significantly lower than surgical circumcision; P < 0.05 Mean pain score at 24 hours: 1.85 (SD 0.63) with DCSD vs 3.18 (SD 0.82) with foreskin cerclage vs 1.82 (SD 0.75) with surgery |
Not reported | Not applicable | Not reported |
| Millard 2013 | Crush | VAS (mean, SD) | Mean pain score: 3.3 (SD 2.7) with device vs 3.3 (SD 2.4) with conventional surgery; P = 0.91 | Mean score at 48 hours: 1.8 (SD 1.6) with device vs 2.5 (SD 1.9) with conventional surgery; P = 0.008 | Not applicable | Not reported |
| Millard 2014 | Crush | VAS (mean, SD) | Mean pain score: 4.2 (SD 2.7) with device vs 3.1 (SD 2.4) with conventional surgery; P = 0.01 | Mean score reported at 48 hours: 0.7 (SD 1.6) with device vs 1.2 (SD 2) with conventional surgery; P = 0.04 | Not applicable | Not reported |
| Mutabazi 2012 | Ligature | VAS (mean, SD) | During placement: mean pain levels: 0.8 (SD 1.2) with device vs 2.4 (SD 0.9) with surgery Mean pain score at 1 hour: 5.6 (SD 1.8) with device vs 3.8 (SD 2.1) with surgery Mean pain score at 2 hours: 4.1 (SD 1.9) with device vs 2.3 (SD 1.6) with surgery Mean pain score at 3 hours: 2.8 (SD 1.8) with device vs 1.4 (SD 1.5) with surgery Mean pain score at 4 hours: 1.9 (SD 1.5) with device vs 0.9 (SD 1.3) with surgery Mean pain score at 8 hours: 1.1 (SD 1.6) with device vs 0.7 (SD 1.2) with surgery Mean pain score at 16 hours: 0.3 (SD 0.8) with device vs 0.9 (SD 1.5) with surgery Statistical difference between groups were not reported |
Not reported | Mean pain levels were 4.7 (SD 1.9) during device removal vs 1.4 (SD 1.6) 1 hour immediately after removal. Statistical significance not reported |
Mean pain levels during erection at day 3: 2.5 (SD 1.8) with device vs 5.2 (SD 2.2) with surgical methods. Mean pain score during erection at day 9: 1.9 (SD 1.5) with device. The pain scores during erection for the surgical group was significant higher compared with the PrePex group (P<0.0001). |
| Pang 2015 | Crush | Not reported | Not reported | Not reported | Not applicable | Not reported |
| Ren 2014 | Crush | Not reported | Not reported | Not reported | Not applicable | Not reported |
| Shenje 2016 | Crush | VAS (Median, IQR) | Median intraoperative pain score: 1 (IQR 0.5–2) with device vs 1 (IQR 0 to 2) with surgery Median immediate postoperative pain score: 1 (IQR 0.5–2) with device vs 1 (IQR 0–5) with surgery |
Not reported | Not applicable | Not reported |
| Sokal 2014 | Crush | VAS (mean, SD) and VAS (median, IQR) | Immediately after procedure and 1 hour: Kenya: pain scores: 0.2 with device vs 1.2 with surgery (P < 0.001), but was the same 1 hour after surgery (combined mean 3.8 [SD 1.8]). Zambia: pain scores: 0.6 with device vs 0.2 with surgery (P = 0.046), but were similar 1 hour after surgery (combined mean 3.4 [SD 1.9]) | At 2 days: similar pain scores in both groups with median VAS scores of 1.0 | Not reported | SR had worse pain during erections: 3.5 (SD 1.9) with SR vs 2.3 (SD 1.7) with surgery (P < 0.001). This required early removal in 2 cases |
| Tshimanga 2016 | Ligature | VAS (categories 0, 2, 4, 6, 8) with percentages of participants experiencing pain at these levels | Periprocedurally: all participants in device groups had VAS score of 0, while over 90% in surgical group had a VAS score 4–6. After procedure: device group had VAS score of 0 up to 3 hours while surgical group had VAS score 0–2. No statistical differences were reported | 111/160 (69%) participants experienced pain (VAS 0–2) at end of the first week with the device vs 14/80 (17.5%) participants with surgery | Transient pain (VAS 2–6) reported in 93.6% of device group. Pain after removal reported in 66% | Pain during erection (VAS 2–4): 81/160 (51%) participants with device vs 57/80 (71%) participants with surgery |
| Wang 2014 | Crush | Categorically: minor (no/slight pain), moderate (tolerable pain) and severe (intolerable pain requiring medication or intervention with acetaminophen) on days 1, 3, 7 and 14; with numbers per category | 53 minor pain, 4 moderate pain and 1 severe pain with devices vs 54 minor pain, 6 moderate pain and 0 severe pain | Day 3 | — | — |
| Wang 2017 | Crush | VAS (the units of measurement, i.e. mean/median, were not specified) | Pain scores: 6 hours after operation: 5.13 (SD 1.14) with disposable stitching device vs 7.16 (SD 1.23) with surgery; P < 0.0001 12 hours after operation: 3.16 (SD 1.13) with disposable stitching device vs 5.33 (SD 1.25) with surgery; P < 0.0001 24 hours after operation: 1.85 (SD 1.14) with disposable stitching device vs 3.58 (SD 1.26) with surgery; P < 0.0001 Postoperative VAS score improvements in the device group were significantly higher than those of the surgery group at the time points specified |
Not reported | Not applicable | Not reported |
CI: confidence interval; DCSD: disposable circumcision disposable device; FG: forceps guided; IQR: interquartile range; n: number; RR: risk ratio; SD: standard deviation; SR: Shang Ring; TK: Tara KLamp; VAS: visual analog scale