Background/Purpose: Pain is a frequent, yet inadequately explored challenge in patients with systemic sclerosis (SSc). The aim of this study was to conduct an extensive pain assessment, examining pain chronification and its association with disease manifestation.

Methods: Consecutive SSc patients attending their annual assessment in the Department of Rheumatology, Zurich, Switzerland were included into the study. SSc specific features were addressed as defined by European Scleroderma Trial and Research Group (EUSTAR). We conducted a detailed pain analysis including pain intensity, localization, treatment, pain chronification grade according to the Mainz Pain Staging System (MPSS), general well-being using the Marburg questionnaire on habitual health findings (MFHW), as well as symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).

Results: One hundred forty seven SSc patients completed a pain questionnaire, 118/147 (80.3%) reported pain and were included for further assessment. The median pain intensity during the last 4 weeks was 4/10 on a numeric rating scale (NRS). The most frequent major pain localizations were hand and lower back. The number of patients with low back pain as main pain was significantly higher in patients with very early SSc than in patients with advanced and established disease stages (p = 0.01). Those patients also showed the highest amount of pathological HADS scores for depression as well as for anxiety with 25% each and more pathological scores in the MFHW. Regarding pain chronification, 34.8% of all patients were in stage I according to the Mainz Pain Staging System, 45.2% in stage II and 20.0% in stage III. There was no significant correlation with chronification grade and disease severity, but higher chronification grades were significantly more frequent in patients with low back pain (p = 0.024). Advanced chronification was also significantly associated with pathological scores in the HADS (p < 0.0001) and was linked with decreased well-being. Therefore, patients with primarily back pain showed more pathological HADS scores than those with primarily hand pain. Patients with higher chronification grades also showed more pain related effects like higher use of analgesics and poorer subjective therapy effects. Furthermore, we found that most patients did not receive adequate pain therapy; only 4.4% of all examined patients reported seeing a pain specialist.

Conclusion: Contrary to our expectations, pain severity and chronification were not associated with more severe disease manifestation in systemic sclerosis. This study showed that low back pain, being associated with advanced pain chronification and increasing psychological problems, represents an important problem in patients with systemic sclerosis, especially in early stages of the disease. Therefore, our study implies that also non-disease specific symptoms such as low back pain need to be considered in SSc patients and it underlines the importance of preventing pain chronification in order to enhance quality of life for these patients.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/pain-chronification-and-the-important-role-of-non-disease-specific-symptoms-in-patients-with-systemic-sclerosis/