Lower Back Pain Likely Drives Chronic Pain in Early Stages of Scleroderma

Although not a distinctive symptom of scleroderma, lower back pain is a major contributor to the chronic pain felt by people in the earliest disease stages, a study based on a patient viewpoints reported.

Physicians should pay more attention to lower back pain and other non-specific symptoms of scleroderma, to counteract pain persistence, and improve care and quality of life for these patients, its researchers advised.

The study, “Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis,” was published in the journal Arthritis Research & Therapy.

Pain is a frequent complaint of people with scleroderma (also known as systemic sclerosis, or SSc), and can be due to a variety of disease-linked causes, like poor gastrointestinal motility, joint contractures, and digital ulcers.

Researchers at the University of Zurich explored the differing types of pain experienced with SSc, their characteristics (intensity, duration, etc.), how pain affected disease course, and factors that contributed to pain turning chronic or persistent.

The recruited scleroderma patients arriving at the university’s hospital for their annual checkup. All were enrolled in the European Scleroderma Trials and Research (EUSTAR) registry.

Patients were asked to complete a questionnaire looking into the distribution, duration, and intensity of their pain, along with their overall well-being and quality of life.

Pain chronification, or persistence, was evaluated with the Mainz Pain Staging System (MPSS), a three-stage scale with higher stages corresponding to more persistent pain. Overall well-being was assessed using the Marburg questionnaire on habitual health findings (MFHW), while evidence of depression and anxiety was evaluated via the Hospital Anxiety and Depression Scale (HADS).

Of the 147 patients who completed the questionnaire, 29 were excluded from the final analyses for reasons that included reporting no pain or having comorbidites (other health conditions) that could affect or bias outcomes.

Of the 118 patients reporting pain — 104 women and 14 men, mean age of 57 — a majority (65 or 55.1%) had “established” disease, meaning they met SSc criteria defined by the American College of Rheumatology. The other 53 patients were considered to have a “mild” or “very early” form of scleroderma, according to these same criteria.

Among this overall group, median pain intensity over the previous month was found to be 4 on a 0–10 scale. Pain intensity tended to be higher in patients with established scleroderma, but the differences did not reach statistical significance.

The hands and lower back were sites of the most frequent pain, patients reported. Hand pain was more prevalent in people with more advanced disease (49.2%), and lower back pain in those at the “very early” disease stage (27.3%).

Additional analyses found that depression and anxiety, whose symptoms corresponded to poorer HADS scores, were more common in patients with early scleroderma, and in those with lower back pain compared with patients with hand pain.

Pain was persistent, or chronic, in nearly half (45.2%) of these patients, determined by responses to be at the intermediate stage (stage 2) for chronic pain under the MPSS.

Statistical analyses failed to identify a correlation between pain persistence and disease severity. But more advanced chronic pain was associated with lower back pain. It also linked with the presence of depression and/or anxiety, as well as with a poorer overall quality of life, and greater reliance on painkillers.

“Our study showed that low back pain is a major driver of pain in patients with very early disease. It is associated with higher pain chronification, depression and anxiety and has therefore major impact on well-being particularly in this patient group. It therefore needs particular attention in the care of patients with very early SSc,” the researchers concluded.