Pain, psychological factors and physical function closely linked in people with systemic sclerosis

For many people living with chronic conditions like systemic sclerosis, pain can be persistent, unpredictable and difficult to manage.

This can affect mood, worry, sleep, motivation and confidence in completing daily activities.

Daniel Whibley, Ph.D., an Assistant Professor of Physical Medicine and Rehabilitation at University of Michigan Health, recently examined how pain intensity, physical function and psychosocial factors are related in adults living with systemic sclerosis.

Using data collected as part of a larger treatment study led by Susan Murphy, S.C.D., O.T.R., a Professor in Physical Medicine and Rehabilitation and Rheumatology at U-M Health and her team at the Telehealth and Rehabilitation Advancing Chronic Condition Research Center at U-M, Whibley and colleagues examined relationships between pain intensity, physical function, and psychosocial factors including anxiety, negative affect, resilience, depression and self-efficacy at a single point in time.

In the research published in Sage Journals, the team found that higher pain intensity was associated with poorer physical function.

Importantly, anxiety and negative affect appeared to strengthen that relationship.

Among people with higher levels of anxiety or negative affect, pain had a stronger association with limitations in physical function.

“Pain, psychological factors, and physical function were closely linked in our study,” said Whibley.

“Specifically, higher pain intensity was associated with poorer physical function, and that association was stronger among people reporting higher levels of anxiety or negative affect.”

Because the study was cross-sectional, the researchers cannot determine the direction of these relationships.

From a clinical perspective, however, Whibley says the findings highlight the importance of considering the broader context within which people experience pain.

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“If we restrict our focus to physical sources of pain, we may miss other important factors that affect a person’s daily life, not allowing us to see the full picture for treatment,” he said. 

“The findings highlight the importance of considering the emotional and psychological context when supporting people with systemic sclerosis-related pain.”

This doesn't mean that pain in systemic sclerosis is psychological.

People with systemic sclerosis can experience complex disease-related sources of pain involving the skin, joints, muscles, blood vessels, gastrointestinal system and other parts of the body.

Rather, Whibley says comprehensive pain care should recognize that physical symptoms, psychological and emotional factors, behavior and daily functioning can be interconnected.

Whibley says patients should feel comfortable discussing psychological or emotional symptoms with their provider and do not need to wait until symptoms become severe.

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Depending on an individual’s needs, care may include treatment of underlying systemic sclerosis symptoms, pain management, physical or occupational therapy, support for sleep and activity, psychological therapies or other approaches as part of multidisciplinary care.

While the study identified relationships between pain, psychosocial factors and physical function, Whibley and his colleagues say further research is needed to understand how these relationships develop over time.

“Because this study looked at people at a single point in time, we cannot determine the direction of these relationships,” said Whibley.

“Future studies that follow people over time can help us understand how pain, psychological factors and physical function influence one another, and whether addressing these factors can ultimately improve function and quality of life.”

Additional authors: Deeba Minhas, and Dinesh Khanna, Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. John A. Sturgeon, Department of Anesthesiology, Medical School, University of Michigan, Ann Arbor, MI, USA. Yen T. Chen, Department of Physical Medicine and Rehabilitation and Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. Anna Kratz, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.

Paper cited: “Psychosocial moderators of the association between pain intensity and physical function in people with systemic sclerosis,” Sage Journals. DOI: 10.1177/23971983241312542

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