Background/Purpose: Despite being a common problem in Systemic Sclerosis, the extant literature on pain has primarily focused on biomedical correlates, or bivariate relationships with a few psychological characteristics. There is a need to investigate the more heuristic biopsychosocial model, which incorporates the simultaneous contributions of medical, psychological, and social variables in understanding pain.

Methods: Patients with Systemic Sclerosis (N = 333) received clinical exams and completed self-report surveys at enrollment to the Genetics versus ENvironment In Scleroderma Outcome Study. Latent profile analysis was used to derive biopsychosocial profiles of patients using clinical indicators of disease severity (modified Rodnan skin score, percent predicted forced vital lung capacity), perceived physical health, health worry, mental health, and social support. The resultant profiles were examined in relation to pain and pain medication usage.

Results: A 3-profile solution provided the best fit to the data. Based on the biopsychosocial indicators, the profiles were characterized as Managing (n = 217), Resilient (n = 86), and Distressed (n = 30). Both the Managing and Distressed groups had relatively less severe skin thickening and percent predicted forced vital lung capacity, but the Distressed group reported much poorer perceived physical health, mental health, and social support. The Resilient group had a much more severe disease manifestation; however, Resilient patients mirrored the Managing group with relatively better psychosocial functioning. Between-group differences for pain emerged, with the Distressed group, whose disease was less severe than the Resilient group, reporting the highest pain and the greatest utilization of acetaminophen/non-steroidal anti-inflammatory drugs, tramadol, and narcotic pain medication.

Conclusion: Clinicians should consider biopsychosocial characteristics as contributing factors to the experience of pain in patients with Systemic Sclerosis. Although disease severity is a risk factor for pain, psychological and social characteristics are also important in understanding disease-related pain. Patients with characteristics similar to those in the Distressed profile may be at an increased risk for pain and would likely benefit from a referral to a behavioral health or other ancillary service providers for an adjunct treatment for pain management, rather than relying solely on pharmacological therapies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biopsychosocial-typologies-of-pain-in-a-cohort-of-patients-with-systemic-sclerosis/