{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:21:57Z","timestamp":1777983717760,"version":"3.51.4"},"reference-count":25,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Digital ulcers represent a severe manifestation of digital vasculopathy in systemic sclerosis, occasionally with the contribution of microtrauma and calcinosis. These ulcers are often challenging to heal and extremely painful. Regarding analgesic approaches, there is a lack of consensus on best practices, leading to physician experience-guided approaches rather than standardized protocols. To assess the published evidence on the effectiveness of oral and topical analgesics and local anaesthetics for pain reduction in digital ulcer of systemic sclerosis, we conducted a PRISMA-driven systematic review. A search in PubMed and Cochrane databases was performed using the keyword search terms \u2018digital ulcers\u2019, \u2018finger ulcers\u2019, \u2018systemic sclerosis\u2019, \u2018scleroderma\u2019, \u2018pain management\u2019, \u2018analgesics\u2019, \u2018anaesthetics\u2019 and \u2018painkillers\u2019, with the Boolean terms \u2018AND\u2019 and \u2018OR\u2019. Original studies and case reports were considered for inclusion. Results were screened by title, abstract and full-text. We identified a total of 26 results, of which 5 original papers were included: 2 prospective observational studies, 1 prospective case series, 1 retrospective case series and 1 case report. The evaluated pharmacological strategies were digital nerve block with lidocaine and mepivacaine (one study), oral extended-release oxycodone (two studies), local lidocaine (one study), local lidocaine and prilocaine, local morphine and sublingual morphine (one study). Overall, digital nerve block appeared to provide complete or near-complete pain relief. Oral and topical strategies resulted in reduced pain intensity, although levels remained in the mild-to-moderate range. Concerning adverse outcomes, all strategies were generally well tolerated, with only mild effects reported across studies. Despite limitations, the available evidence suggests that the evaluated analgesics and anaesthetics may provide pain relief for digital ulcer in patients with systemic sclerosis. Future larger-scale studies employing standardized protocols are necessary to further assess the efficacy, optimal dosing and long-term outcomes of these interventions.<\/jats:p>","DOI":"10.1177\/23971983251352340","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T14:25:13Z","timestamp":1753367113000},"page":"200-211","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Pharmacological management of pain in digital ulcers of systemic sclerosis: A PRISMA-driven systematic review"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1825-209X","authenticated-orcid":false,"given":"In\u00eas","family":"Almeida","sequence":"first","affiliation":[{"name":"Rheumatology Unit, ULS Viseu D\u00e3o-Laf\u00f5es, Viseu, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Dourado","sequence":"additional","affiliation":[{"name":"Pharmaceutics Department, ULS de Matosinhos, Matosinhos, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu\u00eds","family":"Agualusa","sequence":"additional","affiliation":[{"name":"Anaesthetics Department, ULS de Matosinhos, Matosinhos, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30933-9"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01692-0"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.114264"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcp174"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev201"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.5301\/jsrd.5000236"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew047"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2017.11.020"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/14656566.2023.2213434"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207271"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24127"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-019-04436-z"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-226430"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.63032\/YLKM7405"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.63032\/YHBL8967"},{"issue":"9","key":"e_1_3_2_17_2","first-page":"1801","article-title":"Statins: potentially useful in therapy of systemic sclerosis-related Raynaud\u2019s phenomenon and digital ulcers","volume":"35","author":"Abou-Raya A","year":"2008","unstructured":"Abou-Raya A, Abou-Raya S, Helmii M. Statins: potentially useful in therapy of systemic sclerosis-related Raynaud\u2019s phenomenon and digital ulcers. J Rheumatol 2008; 35(9): 1801\u20131808.","journal-title":"J Rheumatol"},{"key":"e_1_3_2_18_2","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.","journal-title":"BMJ"},{"key":"e_1_3_2_19_2","article-title":"Efficacy and safety of digital nerve block for pain management during sharp debridement of digital ulcers in systemic sclerosis: a prospective observational study","volume":"9","author":"Bixio R","year":"2024","unstructured":"Bixio R, Mastropaolo F, Nava F, et al. Efficacy and safety of digital nerve block for pain management during sharp debridement of digital ulcers in systemic sclerosis: a prospective observational study. J Scleroderma Relat Disord 2024; 9: 23971983241285206.","journal-title":"J Scleroderma Relat Disord"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2010.00849.x"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3414-7"},{"issue":"1","key":"e_1_3_2_22_2","first-page":"5","article-title":"Procedural pain management in the treatment of scleroderma digital ulcers","volume":"33","author":"Giuggioli D","year":"2015","unstructured":"Giuggioli D, Manfredi A, Vacchi C, et al. Procedural pain management in the treatment of scleroderma digital ulcers. Clin Exp Rheumatol 2015; 33(1): 5\u201310.","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_3_2_23_2","first-page":"307","article-title":"Effectiveness and safety of oxycodone\/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports","volume":"11","author":"Ughi N","year":"2016","unstructured":"Ughi N, Crotti C, Ingegnoli F. Effectiveness and safety of oxycodone\/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports. Clin Interv Aging 2016; 11: 307\u2013311.","journal-title":"Clin Interv Aging"},{"key":"e_1_3_2_24_2","article-title":"Reliability and validity of the Italian version of the UCLA scleroderma clinical trial consortium gastrointestinal tract instrument in patients with systemic sclerosis","volume":"33","author":"Gualtierotti R","year":"2015","unstructured":"Gualtierotti R, Ingegnoli F, Two R, et al. 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