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. 2021 Jan 19;23(1):34.
doi: 10.1186/s13075-021-02421-1.

Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis

Caroline Evers  1 , Suzana Jordan  1 , Britta Maurer  1 , Mike Oliver Becker  1 , Carina Mihai  1 , Rucsandra Dobrota  1 , Petra Hoederath #  1   2 , Oliver Distler #  3
Affiliations

Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis

Caroline Evers et al. Arthritis Res Ther. .

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.

Keywords: Chronification; Non-disease-specific symptoms; Pain; Systemic sclerosis.

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Conflict of interest statement

OD: consultancy relationship and/or received research funding (last 3 years) from Abbvie, Actelion, Acceleron Pharma, Amgen, AnaMar, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, Catenion, Competitive Drug Development International Ltd., CSL Behring, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, Glenmark Pharmaceuticals, GSK, Inventiva, Italfarmaco, iQone, iQvia, Lilly, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Target BioScience and UCB in the area of potential treatments of scleroderma and its complications. In addition, OD has a patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143).

PH: speaker fee: Grünenthal Pharma AG, Nevro Medical Ltd.

CM: Consultancy fees from Boehringer-Ingelheim and mepha, as well as congress support from Roche and Actelion.

RD: grants from Articulum Fellowship, sponsored by Pfizer (2013-2014), and Actelion; speaker fees from Actelion and consultancy fees from Boehringer-Ingelheim in the field of systemic sclerosis, outside the submitted work.

BM: grant/research support from AbbVie, Protagen and Novartis Biomedical Research and speaker fees from Boehringer-Ingelheim as well as congress support from Pfizer, Roche, Actelion, mepha and MSD. In addition, BM has a patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143).

Figures

Fig. 1
Fig. 1
Frequencies for the main pain localizations compared between the groups “very early”, “mild” and “established”, showing a decrease of back pain and an increase of hand pain with progressing disease manifestation
Fig. 2
Fig. 2
Distribution of pain chronification stages compared between the groups “very early”, “mild” and “established”, showing no association between pain chronification and disease severity
See this image and copyright information in PMC

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