Background Anxiety and depression are frequently associated with Sjogren’s syndrome and pain is a common complaint. Patients who experience these problems find their symptoms frightening and possibly more disabling than the sicca symptoms for which PSS is better known. Unfortunately the precise etiology of pain symptoms and the influence of psychological symptoms on pain perception is unknown.
Objectives We investigated 1) the differential effect of depressive symptoms, anxiety, and catastrophizing on pain intensity and health status and 2) compared patients with neuropathic and non-neuropathic pain symptoms.
Methods PSS patients who met AECG criteria (N=95) completed a survey to assess pain intensity: the Brief Pain Inventory1: BPI-S (0-10 scale), neuropathic pain symptoms: the Neuropathic Pain Questionnaire2 (NPP) and affective components of pain: the Pain Anxiety Symptom Scale3 (PASS) and the Pain Catastrophizing Scale4 (PCS). Health status was assessed with the SF-12, perceived stress with a visual analog scale. Linear regression was used to investigate the relationship between pain severity, pain catastrophizing and pain phenotype.
Results PSS subjects were classified into those with neuropathic pain (NP, N=25) and those without neuropathic symptoms (Non-NP, N=59; 11 missing NP status). Daily pain for greater than 3 months was reported by 80% of NP and 49% of Non-NP patients. Based on weekly pain ratings, patients were also divided into: mild pain (N=49) and moderate-severe pain (N=42; 4 missing BPI score) groups. Perceived stress (p=0.015) was associated with more severe pain as were PASS (p=0.015) and PCS (p≤0.001). Pain severity correlated with physical domain of the SF-12(r=-.55), with HAD anxiety (r=0.38), HADs depression (r=0.48) and w/ PASS (r=0.48) and PCS (r=.61). The relationship between pain severity and pain catastrophizing was significant in PSS patients with a history of neuropathy(p=0.027) and in those with a diagnosis of FM (p=0.008). PCS also correlated with musculoskeletal pain severity (r=0.54) and with neuropathic pain symptoms (r=0.58).
Conclusions Pain anxiety and pain catastrophizing are associated with increasing pain severity in PSS patients with different pain phenotypes. This study is consistent with psychological studies that have shown that “pain captures attention” and that patients with pain are hypervigilant for somatic sensations at the expense of other activities. Further study is needed to develop to develop discriminatory classifications of “central pain”, “nociceptive pain” and “neuropathic pain” which could provide insight into mechanistic pathways and a framework for more rationale therapy.
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Disclosure of Interest None Declared