Low Back Pain Is Major Driver of Pain in Very Early Systemic Sclerosis

lower back pain
lower back pain
The researchers conducted an extensive pain assessment of patients with systemic sclerosis, examining pain chronification and its association with disease manifestations.

Non-disease-specific symptoms in systemic sclerosis (SSc), like low back pain, are frequently reported in the early stages of the disease and may be associated with higher pain chronification and psychological issues, according to a study in Arthritis Research & Therapy.

In this study, 147 consecutive patients with SSc who were attending their annual assessment at a European center were evaluated for associations between pain characteristics, chronification, and disease manifestations.

Analyses of pain levels were focused on intensity, localization, treatment, and chronification grade according to the Mainz Pain Staging System (MPSS). Other variables assessed included general well-being according to the Marburg questionnaire on habitual health findings (MFHW), and anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS).

Of the 147 patients who had SSc, a total of 118 reported pain and were included in the final analysis. According to a numeric rating scale, the median pain intensity was 4 out of 10. The hand and lower back were the most frequent major pain localizations. Low back pain represented the primary pain manifestation that was significantly more frequent in patients with very early vs mild and established SSc (62.5% vs 41.4% and 29.2%, respectively; P =.010).

Patients with very early disease and low back pain also had worse HADS and MFHW scores. Higher chronification grades were correlated with significantly higher amounts of positive HADS scores for anxiety (P <.001) and depression (P <.001) as well as with pathologically low scores for well-being as assessed by the MFHW (P =.004).

No significant correlation was found between grade of chronification and disease severity; however, advanced chronification was more frequent in patients who reported low back pain (P =.024). Advanced chronification was also associated with pathological HADS scores (P <.0001) and decreased well-being and higher use of pain medications.

Limitations of this study include its cross-sectional design, the lack of information on the source of hand pain, and the small sample size.

The investigators concluded that “early pain assessments should be conducted in order to detect or prevent pain chronification and associated psychological problems” to improve treatment and quality of life in patients with SSc.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Evers C, Jordan S, Maurer B, et al. Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis. Arthritis Res Ther. 2021;23(1):34. doi:10.1186/s13075-021-02421-1