title: Longitudinal patterns of pain in patients with diffuse and limited systemic sclerosis: integrating medical, psychological, and social characteristics.
abstract: Pain is a common but understudied quality of life concern in systemic sclerosis (SSc). This investigation sought to describe patient-reported pain during the early phase of the disease and to examine potential predictors of this over time.
  
  
  
  A prospective cohort (N = 316) of patients with early-disease SSc from the Genetics versus ENvironment In Scleroderma Outcome Study (GENISOS) were followed for 3 years. Multilevel modeling was used to describe longitudinal changes in pain and the extent to which pain variance was explained by disease type, emotional health, perceived physical health, health worry, and social support.
  
  
  
  Patient-reported pain remained relatively stable, with slight improvement over time. More severe disease type was associated with worse initial pain, but the association was reduced to nonsignificance after accounting for the psychosocial variables. Better emotional health and perceived physical health were associated with lower initial pain. There were marginal interactive effects for perceived physical health and social support such that initial perceptions of poorer physical health, and higher social support, were predictive of greater improvements in pain over time.
  
  
  
  These data suggest that emotional health, perceived physical health, and social support are more relevant to longitudinal SSc pain than disease severity and that perceived physical health and social support may impact pain trajectories. Researchers and rheumatology health professionals should consider these factors in comprehensive pain models and pain management protocols.
authors.affiliation: Department of Psychology, California State University, Dominguez Hills, 1000 E. Victoria Street, Carson, CA, 90747, USA. emerz@csudh.edu.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Merz
authors.affiliation: Department of Psychology, San Diego State University, San Diego, CA, USA.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Malcarne
authors.affiliation: Department of Psychology, San Diego State University, San Diego, CA, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roesch
authors.affiliation: Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Deepthi K
authors.initials: DK
authors.lastname: Nair
authors.affiliation: Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Salazar
authors.affiliation: Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assassi
authors.affiliation: Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Maureen D
authors.initials: MD
authors.lastname: Mayes
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012595:Scleroderma, Systemic / Q000150:complications* / Q000523:psychology
keywords: Multilevel modeling; Pain; Quality of life; Systemic sclerosis