Biopsychosocial Typologies of Pain in a Cohort of Patients With Systemic Sclerosis
Article first published online: 26 MAR 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 4, pages 567–574, April 2014
How to Cite
Merz, E. L., Malcarne, V. L., Assassi, S., Nair, D. K., Graham, T. A., Yellman, B. P., Estrada-Y-Martin, R. M. and Mayes, M. D. (2014), Biopsychosocial Typologies of Pain in a Cohort of Patients With Systemic Sclerosis. Arthritis Care Res, 66: 567–574. doi: 10.1002/acr.22171
- Issue published online: 26 MAR 2014
- Article first published online: 26 MAR 2014
- Accepted manuscript online: 19 SEP 2013 09:30AM EST
- Manuscript Accepted: 10 SEP 2013
- Manuscript Received: 5 JUN 2013
- NIH. Grant Numbers: KL2RR024149, K23AR061436
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases Center of Research Translation in Scleroderma. Grant Number: P50AR054144
- Department of Defense. Grant Number: PR1206877
Despite being a common problem in systemic sclerosis (SSc; scleroderma), the extant literature on pain has primarily focused on biomedical correlates, or bivariate relationships with a few psychological characteristics. There is a need to investigate the more heuristic biopsychosocial model, which incorporates the simultaneous contributions of medical, psychological, and social variables in understanding pain.
Patients with SSc (n = 333) received clinical examinations and completed self-report surveys at enrollment in the Genetics versus Environment in Scleroderma Outcome Study. Latent profile analysis was used to derive biopsychosocial profiles of patients using skin thickening, percent predicted forced vital lung capacity, perceived physical health, health worry, mental health, and social support. The profiles were examined in relation to pain and pain medication usage.
A 3-profile solution provided the best fit to the data. Based on the biopsychosocial indicators, the profiles were characterized as managing (n = 217), resilient (n = 86), and distressed (n = 30). Between-group differences for pain emerged, with the distressed group, whose disease was less severe than the resilient group, reporting the highest pain and the greatest utilization of pain medication.
Clinicians should consider biopsychosocial characteristics as contributing factors to the experience of pain in patients with SSc. Patients who are similar to those in the distressed profile may be at an increased risk for pain and would likely benefit from a referral to a behavioral health or other ancillary service provider for pain management, rather than relying solely on pharmacologic therapies.