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Evers C, Jordan S, Maurer B, Becker MO, Mihai C, Dobrota R, Hoederath P, Distler O. Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis. Arthritis Res Ther 2021; 23:34. [PMID: 33468227 PMCID: PMC7816465 DOI: 10.1186/s13075-021-02421-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pain is a frequent, yet inadequately explored challenge in patients with systemic sclerosis (SSc). This study aimed to conduct an extensive pain assessment, examining pain chronification and its association with disease manifestations. Methods Consecutive SSc patients attending their annual assessment were included. SSc-specific features were addressed as defined by the European Scleroderma Trials and Research (EUSTAR) guidelines. Pain analysis included intensity, localization, treatment, chronification grade according to the Mainz Pain Staging System (MPSS), general well-being using the Marburg questionnaire on habitual health findings (MFHW) and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Results One hundred forty-seven SSc patients completed a pain questionnaire, and 118/147 patients reporting pain were included in the analysis. Median pain intensity was 4/10 on a numeric rating scale (NRS). The most frequent major pain localizations were hand and lower back. Low back pain as the main pain manifestation was significantly more frequent in patients with very early SSc (p = 0.01); those patients also showed worse HADS and MFHW scores. Regarding pain chronification, 34.8% were in stage I according to the MPSS, 45.2% in stage II and 20.0% in stage III. There was no significant correlation between chronification grade and disease severity, but advanced chronification was significantly more frequent in patients with low back pain (p = 0.024). It was also significantly associated with pathological HADS scores (p < 0.0001) and linked with decreased well-being and higher use of analgesics. Conclusions Our study implies that also non-disease-specific symptoms such as low back pain need to be considered in SSc patients, especially in early disease. Since low back pain seems to be associated with higher grades of pain chronification and psychological problems, our study underlines the importance of preventing pain chronification in order to enhance the quality of life.
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Affiliation(s)
- Caroline Evers
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Petra Hoederath
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.,Centre of Neurosurgery Hirslanden Ostschweiz, Paintherapy Stephanshorn, Brauerstrasse 95a, 9016, St. Gallen, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.
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