Comparison of pain, pain burden, coping strategies, and attitudes between patients with systemic sclerosis and patients with rheumatoid arthritis: a cross-sectional study.

OBJECTIVES: To analyze pain in systemic sclerosis (SSc), especially its impact and coping strategies, compared with the reference painful inflammatory rheumatological condition, rheumatoid arthritis (RA). METHODS: We carried out a cohort study of consecutive inpatients with SSc and RA visiting three university hospitals. We analyzed pain, pain-related interference with daily life, pain catastrophizing, and attitudes, together with quality of life (QoL). RESULTS: In total, 173 patients were included and 153 were analyzed: 82 SSc and 71 RA patients. Pain frequency did not differ between the two groups (60.8% and 73.1%, respectively), but pain dimension scores in SSc patients were not correlated with disease activity and were significantly lower than those in RA patients. A neuropathic component was associated with higher pain scores in both conditions. Pain was more frequent and more intense in patients with diffuse cutaneous SSc than in patients with limited SSc, but its impact was similar. Pain and its functional consequences interfered less with daily life in SSc than in RA, consistent with the lower expectations concerning the benefits of drug treatment in SSc. However, pain catastrophizing played an important role in both groups. CONCLUSION: Pain intensity and dimension scores are lower in SSc patients, particularly those with limited disease, than in RA patients and are not correlated with disease activity. In both conditions, a neuropathic component is associated with higher pain scores and pain catastrophizing is frequent.

eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study.

BACKGROUND: Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. OBJECTIVE: We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. METHODS: We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. RESULTS: Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. CONCLUSIONS: This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. TRIAL REGISTRATION: ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694.

Relieving pain in rheumatology patients: repetitive transcranial magnetic stimulation (rTMS), a developing approach.

Transcranial magnetic stimulation (TMS) is a non-invasive method for activating specific areas of the brain. There are two variants, repetitive TMS (rTMS) and direct TMS. Rapid changes in an electrical current induce a magnetic field, which in turn induces an electrical current in a nearby conductor. When a coil is positioned over the brain, rTMS delivers very brief and painless magnetic pulses to the brain. Initially, rTMS was developed as a treatment for depression. Since then, potential indications have been extended to the treatment of chronic pain, most notably in patients with rheumatic diseases. Thus, active research is being conducted into rTMS effects in fibromyalgia, chronic low back pain, and type I complex regional pain syndrome. Studies have established that rTMS is safe; provides pain relief, at least in the short-term; and improves the psychological correlates of chronic pain. These data support further development efforts with the goal of using rTMS in patients with chronic pain, including those with rheumatic diseases. French physicians have shown a high level of interest in rTMS, and the first French recommendations for using this method were issued in 2011. Further research is needed to determine the optimal stimulation parameters, session frequency, and session duration, as well as the best indications. Physicians who see many patients with chronic pain, such as rheumatologists, should be aware of this developing non-pharmacological and safe treatment modality, which can be of considerable help to their patients.