Pain and Psychological Distress in Patients With Systemic Lupus Erythematosus: Comment on the Article by Somers et al


We read with great interest the article by Somers et al published recently in Arthritis Care & Research (1). The authors carried out an investigation to determine how self-efficacy for pain control and pain catastrophizing are related to pain, stiffness, fatigue, and psychological distress in patients with systemic lupus erythematosus (SLE). Somers et al observed that patients with low self-efficacy for pain control were much more likely to report symptoms of pain, stiffness, fatigue, and psychological distress. Individuals with SLE commonly report symptoms like pain, fatigue, and stiffness even in periods of disease quiescence, resulting in a compromised quality of life (QOL). We propose that one of the reasons individuals with SLE commonly report these symptoms is that they experience a high level of chronic stress (higher than that of the general population), which is associated with the exacerbation of symptoms, even pain ([2]).

It is known that patients with SLE usually have fewer coping strategies than the general population, and these strategies are often less effective. In addition, patients with SLE experience higher psychological distress, stress, and physical symptoms (most notably pain) than other patients with chronic diseases.

Regarding the suggestion by Somers et al that future studies should consider designing psychological interventions to address pain coping cognitions in patients with SLE, we performed a randomized controlled trial with the main objective of verifying the efficacy of cognitive–behavioral therapy (CBT) for coping with chronic stress in patients with SLE by assessing the activity level of the disease, somatic symptoms, psychological variables, QOL, and immunologic and other serologic parameters ([3]). Patients who received the intervention showed a significant reduction in their level of pain and other somatic symptoms and significant improvement of anxiety, depression, and mental and physical QOL.

As Somers et al conclude, pain coping cognitions are significantly related to physical symptoms and psychological distress in patients with SLE. The results of studies that included other samples of patients with persistent pain conditions other than SLE have shown that psychological interventions to improve coping strategies may produce psychologically and physically favorable effects in patients with SLE. Physicians should consider these kinds of treatments in the global management of SLE to improve the QOL of their patients.