{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T06:53:43Z","timestamp":1770792823051,"version":"3.50.0"},"reference-count":61,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Pain is a frequent, yet inadequately explored challenge in patients with systemic sclerosis (SSc). This study aimed to conduct an extensive pain assessment, examining pain chronification and its association with disease manifestations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Consecutive SSc patients attending their annual assessment were included. SSc-specific features were addressed as defined by the European Scleroderma Trials and Research (EUSTAR) guidelines. Pain analysis included intensity, localization, treatment, chronification grade according to the Mainz Pain Staging System (MPSS), general well-being using the Marburg questionnaire on habitual health findings (MFHW) and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One hundred forty-seven SSc patients completed a pain questionnaire, and 118\/147 patients reporting pain were included in the analysis. Median pain intensity was 4\/10 on a numeric rating scale (NRS). The most frequent major pain localizations were hand and lower back. Low back pain as the main pain manifestation was significantly more frequent in patients with very early SSc (<jats:italic>p<\/jats:italic>\u2009=\u20090.01); those patients also showed worse HADS and MFHW scores. Regarding pain chronification, 34.8% were in stage I according to the MPSS, 45.2% in stage II and 20.0% in stage III. There was no significant correlation between chronification grade and disease severity, but advanced chronification was significantly more frequent in patients with low back pain (<jats:italic>p\u2009=<\/jats:italic>\u00a00.024). It was also significantly associated with pathological HADS scores (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and linked with decreased well-being and higher use of analgesics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our study implies that also non-disease-specific symptoms such as low back pain need to be considered in SSc patients, especially in early disease. Since low back pain seems to be associated with higher grades of pain chronification and psychological problems, our study underlines the importance of preventing pain chronification in order to enhance the quality of life.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13075-021-02421-1","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T19:03:01Z","timestamp":1611082981000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis"],"prefix":"10.1186","volume":"23","author":[{"given":"Caroline","family":"Evers","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzana","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Britta","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike Oliver","family":"Becker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina","family":"Mihai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rucsandra","family":"Dobrota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Hoederath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0546-8310","authenticated-orcid":false,"given":"Oliver","family":"Distler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,19]]},"reference":[{"issue":"3","key":"2421_CR1","doi-asserted-by":"publisher","first-page":"137","DOI":"10.5301\/jsrd.5000249","volume":"2","author":"J Varga","year":"2017","unstructured":"Varga J, Trojanowska M, Kuwana M. Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord. 2017;2(3):137\u201352.","journal-title":"J Scleroderma Relat Disord"},{"issue":"Suppl 3","key":"2421_CR2","first-page":"iii3","volume":"48","author":"DJ Abraham","year":"2009","unstructured":"Abraham DJ, Krieg T, Distler J, Distler O. Overview of pathogenesis of systemic sclerosis. Rheumatology (Oxford). 2009;48(Suppl 3):iii3\u20137.","journal-title":"Rheumatology (Oxford)"},{"issue":"1","key":"2421_CR3","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.berh.2015.05.006","volume":"29","author":"M Di Franco","year":"2015","unstructured":"Di Franco M, Bazzichi L, Casale R, Sarzi-Puttini P, Atzeni F. Pain in systemic connective tissue diseases. Best Pract Res Clin Rheumatol. 2015;29(1):53\u201362.","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2421_CR4","doi-asserted-by":"publisher","first-page":"44","DOI":"10.4081\/reumatismo.2014.764","volume":"66","author":"S Stisi","year":"2014","unstructured":"Stisi S, Sarzi-Puttini P, Benucci M, Biasi G, Bellissimo S, Talotta R, et al. Pain in systemic sclerosis. Reumatismo. 2014;66:44\u20137.","journal-title":"Reumatismo."},{"issue":"10","key":"2421_CR5","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1093\/rheumatology\/kel247","volume":"45","author":"PE Carreira","year":"2006","unstructured":"Carreira PE. \u2018Quality of pain\u2019 in systemic sclerosis. Rheumatology (Oxford). 2006;45(10):1185\u20136.","journal-title":"Rheumatology (Oxford)"},{"key":"2421_CR6","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1002\/acr.20108","volume":"62","author":"O Schieri","year":"2010","unstructured":"Schieri O, Thombs BD, Hudson M, Boivin J-F, Steele R, Bernatsky S, et al. Prevalence, severity, and clinical correlates of pain in patients with systemic sclerosis. Arthritis Care Res. 2010;62:409\u201317.","journal-title":"Arthritis Care Res"},{"issue":"3","key":"2421_CR7","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/S0304-3959(01)00409-2","volume":"95","author":"LM Benrud-Larson","year":"2002","unstructured":"Benrud-Larson LM, Haythornthwaite JA, Heinberg LJ, Boling C, Reed J, White B, et al. The impact of pain and symptoms of depression in scleroderma. Pain. 2002;95(3):267\u201375.","journal-title":"Pain."},{"issue":"4","key":"2421_CR8","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1093\/rheumatology\/keq310","volume":"50","author":"M Bassel","year":"2011","unstructured":"Bassel M, Hudson M, Taillefer SS, Schieir O, Baron M, Thombs BD. Frequency and impact of symptoms experienced by patients with systemic sclerosis: results from a Canadian National Survey. Rheumatology (Oxford). 2011;50(4):762\u20137.","journal-title":"Rheumatology (Oxford)"},{"issue":"8","key":"2421_CR9","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1002\/art.24676","volume":"61","author":"M Hudson","year":"2009","unstructured":"Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M, et al. Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum. 2009;61(8):1112\u201320.","journal-title":"Arthritis Rheum"},{"issue":"4","key":"2421_CR10","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3899\/jrheum.080281","volume":"36","author":"M Hudson","year":"2009","unstructured":"Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M, et al. Quality of life in patients with systemic sclerosis compared to the general population and patients with other chronic conditions. J Rheumatol. 2009;36(4):768\u201372.","journal-title":"J Rheumatol"},{"issue":"1","key":"2421_CR11","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.semarthrit.2016.02.005","volume":"46","author":"C Frantz","year":"2016","unstructured":"Frantz C, Avouac J, Distler O, Amrouche F, Godard D, Kennedy AT, et al. Impaired quality of life in systemic sclerosis and patient perception of the disease: a large international survey. Semin Arthritis Rheum. 2016;46(1):115\u201323.","journal-title":"Semin Arthritis Rheum"},{"issue":"10","key":"2421_CR12","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1093\/rheumatology\/kel189","volume":"45","author":"C Georges","year":"2006","unstructured":"Georges C, Chassany O, Toledano C, Mouthon L, Tiev K, Meyer O, et al. Impact of pain in health related quality of life of patients with systemic sclerosis. Rheumatology (Oxford). 2006;45(10):1298\u2013302.","journal-title":"Rheumatology (Oxford)"},{"issue":"2","key":"2421_CR13","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.semarthrit.2007.03.008","volume":"37","author":"TN Hyphantis","year":"2007","unstructured":"Hyphantis TN, Tsifetaki N, Siafaka V, Voulgari PV, Pappa C, Bai M, et al. The impact of psychological functioning upon systemic sclerosis patients\u2019 quality of life. Semin Arthritis Rheum. 2007;37(2):81\u201392.","journal-title":"Semin Arthritis Rheum"},{"issue":"1","key":"2421_CR14","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jpainsymman.2015.12.314","volume":"52","author":"M Racine","year":"2016","unstructured":"Racine M, Hudson M, Baron M, Nielson WR, Group CSR. The impact of pain and itch on functioning and health-related quality of life in systemic sclerosis: an exploratory study. J Pain Symptom Manag. 2016;52(1):43\u201353.","journal-title":"J Pain Symptom Manag"},{"issue":"2","key":"2421_CR15","doi-asserted-by":"publisher","first-page":"e90484","DOI":"10.1371\/journal.pone.0090484","volume":"9","author":"C Nguyen","year":"2014","unstructured":"Nguyen C, Ranque B, Baubet T, B\u00e9rezn\u00e9 A, Mestre-Stanislas C, Rannou F, et al. Clinical, functional and health-related quality of life correlates of clinically significant symptoms of anxiety and depression in patients with systemic sclerosis: a cross-sectional survey. Plos One. 2014;9(2):e90484.","journal-title":"Plos One"},{"issue":"6","key":"2421_CR16","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1002\/art.22910","volume":"57","author":"BD Thombs","year":"2007","unstructured":"Thombs BD, Taillefer SS, Hudson M, Baron M. Depression in patients with systemic sclerosis: a systematic review of the evidence. Arthritis Rheum. 2007;57(6):1089\u201397.","journal-title":"Arthritis Rheum"},{"issue":"12","key":"2421_CR17","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s001150170001","volume":"72","author":"R Nickel","year":"2001","unstructured":"Nickel R, Raspe HH. Chronischer Schmerz: Epidemiologie und Inanspruchnahme. Nervenarzt. 2001;72(12):897\u2013906.","journal-title":"Nervenarzt"},{"issue":"4","key":"2421_CR18","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.ejpain.2005.06.009","volume":"10","author":"H Breivik","year":"2006","unstructured":"Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287\u2013333.","journal-title":"Eur J Pain"},{"issue":"9","key":"2421_CR19","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.mpaic.2016.06.007","volume":"17","author":"T McCormick","year":"2016","unstructured":"McCormick T, Law S. Assessment of acute and chronic pain. Anaesth Intensive Care Med. 2016;17(9):421\u20134.","journal-title":"Anaesth Intensive Care Med"},{"key":"2421_CR20","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1055\/s-2007-985653","volume":"132","author":"P Nilges","year":"2007","unstructured":"Nilges P, Nagel B. Was ist chronischer Schmerz? DMW - Deutsche Medizinische Wochenschrift. 2007;132:2133\u20138.","journal-title":"DMW - Deutsche Medizinische Wochenschrift"},{"issue":"2","key":"2421_CR21","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1097\/00002508-199706000-00006","volume":"13","author":"DA Fishbain","year":"1997","unstructured":"Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997;13(2):116\u201337.","journal-title":"Clin J Pain"},{"issue":"5","key":"2421_CR22","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1111\/pme.12390","volume":"15","author":"BB Annag\u00fcr","year":"2014","unstructured":"Annag\u00fcr BB, Uguz F, Apiliogullari S, Kara I, Gunduz S. Psychiatric disorders and association with quality of sleep and quality of life in patients with chronic pain: a SCID-based study. Pain Med. 2014;15(5):772\u201381.","journal-title":"Pain Med"},{"issue":"1 Suppl","key":"2421_CR23","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.1016\/S0885-3924(02)00411-6","volume":"24","author":"N Katz","year":"2002","unstructured":"Katz N. The impact of pain management on quality of life. J Pain Symptom Manag. 2002;24(1 Suppl):S38\u201347.","journal-title":"J Pain Symptom Manag"},{"issue":"6","key":"2421_CR24","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/papr.12125","volume":"14","author":"RM Leadley","year":"2014","unstructured":"Leadley RM, Armstrong N, Reid KJ, Allen A, Misso KV, Kleijnen J. Healthy aging in relation to chronic pain and quality of life in Europe. Pain Pract. 2014;14(6):547\u201358.","journal-title":"Pain Pract"},{"issue":"5","key":"2421_CR25","doi-asserted-by":"publisher","first-page":"419","DOI":"10.3109\/03009742.2014.881549","volume":"43","author":"SV Bj\u00f6rnsd\u00f3ttir","year":"2014","unstructured":"Bj\u00f6rnsd\u00f3ttir SV, J\u00f3nsson SH, Valdimarsd\u00f3ttir UA. Mental health indicators and quality of life among individuals with musculoskeletal chronic pain: a nationwide study in Iceland. Scand J Rheumatol. 2014;43(5):419\u201323.","journal-title":"Scand J Rheumatol"},{"key":"2421_CR26","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1186\/1471-2458-13-1229","volume":"13","author":"H Breivik","year":"2013","unstructured":"Breivik H, Eisenberg E, O\u2019Brien T, OPENMinds. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health. 2013;13:1229.","journal-title":"BMC Public Health"},{"issue":"4","key":"2421_CR27","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s00482-002-0162-1","volume":"16","author":"B Nagel","year":"2002","unstructured":"Nagel B, Gerbershagen HU, Lindena G, Pfingsten M. Entwicklung und empirische \u00dcberpr\u00fcfung des Deutschen Schmerzfragebogens der DGSS. Schmerz. 2002;16(4):263\u201370.","journal-title":"Schmerz."},{"issue":"4","key":"2421_CR28","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1007\/s00482-003-0227-9","volume":"17","author":"J Frettl\u00f6h","year":"2003","unstructured":"Frettl\u00f6h J, Maier C, Gockel H, H\u00fcppe M. Validit\u00e4t des Mainzer Stadienmodells der Schmerzchronifizierung bei unterschiedlichen Schmerzdiagnosen. Schmerz. 2003;17(4):240\u201351.","journal-title":"Schmerz."},{"issue":"1","key":"2421_CR29","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s004820050003","volume":"14","author":"M Pfingsten","year":"2000","unstructured":"Pfingsten M, Sch\u00f6ps P, Wille T, Terp L, Hildebrandt J. Chronifizierungsausma\u00df von Schmerzerkrankungen Quantifizierung und Graduierung anhand des Mainzer Stadienmodells. Schmerz. 2000;14(1):10\u20137.","journal-title":"Schmerz."},{"issue":"2","key":"2421_CR30","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1136\/annrheumdis-2013-203997","volume":"73","author":"U M\u00fcller-Ladner","year":"2014","unstructured":"M\u00fcller-Ladner U, Tyndall A, Czirjak L, Denton C, Matucci-Cerinic M, Centres E. Ten years EULAR Scleroderma Research and Trials (EUSTAR): what has been achieved? Ann Rheum Dis. 2014;73(2):324\u20137.","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"2421_CR31","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1002\/art.1780230510","volume":"23","author":"AT Masi","year":"1980","unstructured":"Masi AT, Rodnan GP, Medsger TA, Altman RD, D\u2019Angelo WA, Fries JF, et al. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980;23(5):581\u201390.","journal-title":"Arthritis Rheum"},{"issue":"11","key":"2421_CR32","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1136\/annrheumdis-2013-204424","volume":"72","author":"F van den Hoogen","year":"2013","unstructured":"van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology\/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2013;72(11):1747\u201355.","journal-title":"Ann Rheum Dis"},{"key":"2421_CR33","doi-asserted-by":"crossref","unstructured":"Blaja E, Jordan S, Mihai CM, Dobrota R, Becker MO, Maurer B, Matucci-Cerinic M, Distler O. The challenge of very early systemic sclerosis: a combination of mild and early disease? J Rheumatol. 2021;48(1):82\u201386.","DOI":"10.3899\/jrheum.190976"},{"issue":"6","key":"2421_CR34","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1136\/ard.2006.062901","volume":"66","author":"UA Walker","year":"2007","unstructured":"Walker UA, Tyndall A, Czirj\u00e1k L, Denton C, Farge-Bancel D, Kowal-Bielecka O, et al. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis. 2007;66(6):754\u201363.","journal-title":"Ann Rheum Dis"},{"key":"2421_CR35","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.mvr.2013.06.003","volume":"89","author":"F Ingegnoli","year":"2013","unstructured":"Ingegnoli F, Ardoino I, Boracchi P, Cutolo M, Co-authors E. Nailfold capillaroscopy in systemic sclerosis: data from the EULAR Scleroderma Trials and Research (EUSTAR) database. Microvasc Res. 2013;89:122\u20138.","journal-title":"Microvasc Res"},{"issue":"1","key":"2421_CR36","doi-asserted-by":"publisher","first-page":"11","DOI":"10.5301\/jsrd.5000231","volume":"2","author":"D Khanna","year":"2017","unstructured":"Khanna D, Furst DE, Clements PJ, Allanore Y, Baron M, Czirjak L, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. J Scleroderma Relat Disord. 2017;2(1):11\u20138.","journal-title":"J Scleroderma Relat Disord"},{"issue":"5","key":"2421_CR37","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1002\/art.20701","volume":"51","author":"LM Brower","year":"2004","unstructured":"Brower LM, Poole JL. Reliability and validity of the Duruoz Hand Index in persons with systemic sclerosis (scleroderma). Arthritis Rheum. 2004;51(5):805\u20139.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"2421_CR38","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1002\/art.22468","volume":"57","author":"F Rannou","year":"2007","unstructured":"Rannou F, Poiraudeau S, Berezn\u00e9 A, Baubet T, Le-Guern V, Cabane J, et al. Assessing disability and quality of life in systemic sclerosis: construct validities of the Cochin Hand Function Scale, Health Assessment Questionnaire (HAQ), Systemic Sclerosis HAQ, and Medical Outcomes Study 36-Item Short Form Health Survey. Arthritis Rheum. 2007;57(1):94\u2013102.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"2421_CR39","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00296-016-3481-8","volume":"37","author":"N Hylands-White","year":"2017","unstructured":"Hylands-White N, Duarte RV, Raphael JH. An overview of treatment approaches for chronic pain management. Rheumatol Int. 2017;37(1):29\u201342.","journal-title":"Rheumatol Int"},{"issue":"2","key":"2421_CR40","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","volume":"52","author":"I Bjelland","year":"2002","unstructured":"Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69\u201377.","journal-title":"J Psychosom Res"},{"issue":"12","key":"2421_CR41","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1007\/s00296-017-3819-x","volume":"37","author":"ME de Almeida","year":"2017","unstructured":"de Almeida ME, Appenzeller S, Lavras Costallat LT. Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus. Rheumatol Int. 2017;37(12):1999\u20132004.","journal-title":"Rheumatol Int"},{"key":"2421_CR42","unstructured":"Herda CA, Scharfenstein A, Basler H-D. Marburger Fragebogen zum habituellen Wohlbefinden. Med Zentrum f\u00fcr Methodenwiss und Gesundheitsforschung. 1998."},{"issue":"2","key":"2421_CR43","first-page":"202","volume":"15","author":"EC LeRoy","year":"1988","unstructured":"LeRoy EC, Black CM, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15(2):202.","journal-title":"J Rheumatol"},{"issue":"5","key":"2421_CR44","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1002\/art.11385","volume":"49","author":"HL Richards","year":"2003","unstructured":"Richards HL, Herrick AL, Griffin K, Gwilliam PD, Loukes J, Fortune DG. Systemic sclerosis: patients\u2019 perceptions of their condition. Arthritis Rheum. 2003;49(5):689\u201396.","journal-title":"Arthritis Rheum"},{"issue":"2\u20133","key":"2421_CR45","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jad.2012.03.025","volume":"141","author":"W Linden","year":"2012","unstructured":"Linden W, Vodermaier A, Mackenzie R, Greig D. Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord. 2012;141(2\u20133):343\u201351.","journal-title":"J Affect Disord"},{"issue":"3","key":"2421_CR46","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s004820170020","volume":"15","author":"M H\u00fcppe","year":"2001","unstructured":"H\u00fcppe M, Matthiessen V, Lindig M, Preuss S, Meier T, Baumeier W, et al. Vergleich der Schmerzchronifizierung bei Patienten mit unterschiedlicher Schmerzdiagnose. Schmerz. 2001;15(3):179\u201385.","journal-title":"Schmerz."},{"issue":"1","key":"2421_CR47","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00482-010-0999-7","volume":"25","author":"M H\u00fcppe","year":"2011","unstructured":"H\u00fcppe M, Maier C, Gockel H, Zenz M, Frettl\u00f6h J. Behandlungserfolg auch bei h\u00f6herer Schmerzchronifizierung? Eine Auswertung des Mainzer Stadienmodells auf Basis der QUAST-Analysestichprobe. Schmerz. 2011;25(1):77\u201388.","journal-title":"Schmerz."},{"issue":"6","key":"2421_CR48","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s00482-017-0240-z","volume":"31","author":"M H\u00fcppe","year":"2017","unstructured":"H\u00fcppe M, K\u00fckensh\u00f6ner S, Bosse F, Casser H, Kohlmann T, Lindena G, et al. Schmerztherapeutische Versorgung in Deutschland\u2013was unterscheidet ambulante und station\u00e4re Patienten zu Behandlungsbeginn? Pain therapy in Germany\u2013what is the difference between initial outpatient and inpatient treatment? Schmerz. 2017;31(6):559\u201367.","journal-title":"Schmerz"},{"issue":"18","key":"2421_CR49","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1097\/BRS.0b013e318133fad8","volume":"32","author":"CO Schmidt","year":"2007","unstructured":"Schmidt CO, Raspe H, Pfingsten M, Hasenbring M, Basler HD, Eich W, et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine (Phila Pa 1976). 2007;32(18):2005\u201311.","journal-title":"Spine (Phila Pa 1976)"},{"key":"2421_CR50","unstructured":"KochInstitut R. Gesundheit in Deutschland. Gesundheitsberichterstattung des Bundes Gemeinsam getragen von RKI und Destatis Berlin. 2015."},{"issue":"Suppl 2","key":"2421_CR51","doi-asserted-by":"publisher","first-page":"S169","DOI":"10.1007\/s00586-006-1071-2","volume":"15","author":"M van Tulder","year":"2006","unstructured":"van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):S169\u201391.","journal-title":"Eur Spine J"},{"issue":"2","key":"2421_CR52","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s00586-002-0508-5","volume":"12","author":"L Hestbaek","year":"2003","unstructured":"Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149\u201365.","journal-title":"Eur Spine J"},{"issue":"1","key":"2421_CR53","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/j.1532-2149.2012.00170.x","volume":"17","author":"CJ Itz","year":"2013","unstructured":"Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain. 2013;17(1):5\u201315.","journal-title":"Eur J Pain"},{"issue":"1\u20132","key":"2421_CR54","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.pain.2003.09.015","volume":"107","author":"SR Currie","year":"2004","unstructured":"Currie SR, Wang J. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107(1\u20132):54\u201360.","journal-title":"Pain."},{"issue":"3","key":"2421_CR55","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.ejpain.2008.04.005","volume":"13","author":"CM Wenig","year":"2009","unstructured":"Wenig CM, Schmidt CO, Kohlmann T, Schweikert B. Costs of back pain in Germany. Eur J Pain. 2009;13(3):280\u20136.","journal-title":"Eur J Pain"},{"issue":"5","key":"2421_CR56","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1007\/s10198-010-0258-y","volume":"12","author":"S Wieser","year":"2011","unstructured":"Wieser S, Horisberger B, Schmidhauser S, Eisenring C, Br\u00fcgger U, Ruckstuhl A, et al. Cost of low back pain in Switzerland in 2005. Eur J Health Econ. 2011;12(5):455\u201367.","journal-title":"Eur J Health Econ"},{"issue":"5","key":"2421_CR57","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1007\/s00482-014-1471-x","volume":"28","author":"B Arnold","year":"2014","unstructured":"Arnold B, Brinkschmidt T, Casser HR, Diezemann A, Gralow I, Irnich D, et al. Multimodale Schmerztherapie f\u00fcr die Behandlung chronischer Schmerzsyndrome. Schmerz. 2014;28(5):459\u201372.","journal-title":"Schmerz"},{"issue":"2","key":"2421_CR58","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s00337-005-0341-0","volume":"43","author":"A Mesrian","year":"2005","unstructured":"Mesrian A, Neubauer E, Pirron P, Schiltenwolf M. Multimodale Schmerztherapie bei chronischen und chronifizierenden R\u00fcckenschmerzen. Man Med. 2005;43(2):85\u201392.","journal-title":"Man Med"},{"issue":"2","key":"2421_CR59","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.berh.2010.01.011","volume":"25","author":"F Atzeni","year":"2011","unstructured":"Atzeni F, Cazzola M, Benucci M, Di Franco M, Salaffi F, Sarzi-Puttini P. Chronic widespread pain in the spectrum of rheumatological diseases. Best Pract Res Clin Rheumatol. 2011;25(2):165\u201371.","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"3","key":"2421_CR60","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1093\/rheumatology\/kex182","volume":"57","author":"VK Jaeger","year":"2018","unstructured":"Jaeger VK, Distler O, Maurer B, Czirj\u00e1k L, L\u00f3r\u00e1nd V, Valentini G, et al. Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group. Rheumatology (Oxford). 2018;57(3):441\u201350.","journal-title":"Rheumatology (Oxford)"},{"key":"2421_CR61","doi-asserted-by":"publisher","first-page":"216495612094881","DOI":"10.1177\/2164956120948811","volume":"9","author":"T Romeyke","year":"2020","unstructured":"Romeyke T, Noehammer E, Stummer H. Patient-reported outcomes following inpatient multimodal treatment approach in chronic pain-related rheumatic diseases. Glob Adv Health Med. 2020;9:2164956120948811.","journal-title":"Glob Adv Health Med"}],"container-title":["Arthritis Research &amp; Therapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-021-02421-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13075-021-02421-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-021-02421-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T19:15:09Z","timestamp":1611083709000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthritis-research.biomedcentral.com\/articles\/10.1186\/s13075-021-02421-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,19]]},"references-count":61,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2421"],"URL":"https:\/\/doi.org\/10.1186\/s13075-021-02421-1","relation":{},"ISSN":["1478-6362"],"issn-type":[{"value":"1478-6362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,19]]},"assertion":[{"value":"16 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Cantonal Ethics Committee (BASEC-Nr 2017-02115). Written informed consent was obtained from all patients.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"OD: consultancy relationship and\/or received research funding (last 3\u00a0years) from Abbvie, Actelion, Acceleron Pharma, Amgen, AnaMar, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, Catenion, Competitive Drug Development International Ltd., CSL Behring, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, Glenmark Pharmaceuticals, GSK, Inventiva, Italfarmaco, iQone, iQvia, Lilly, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Target BioScience and UCB in the area of potential treatments of scleroderma and its complications. In addition, OD has a patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143).PH: speaker fee: Gr\u00fcnenthal Pharma AG, Nevro Medical Ltd.CM: Consultancy fees from Boehringer-Ingelheim and mepha, as well as congress support from Roche and Actelion.RD: grants from Articulum Fellowship, sponsored by Pfizer (2013-2014), and Actelion; speaker fees from Actelion and consultancy fees from Boehringer-Ingelheim in the field of systemic sclerosis, outside the submitted work.BM: grant\/research support from AbbVie, Protagen and Novartis Biomedical Research and speaker fees from Boehringer-Ingelheim as well as congress support from Pfizer, Roche, Actelion, mepha and MSD. In addition, BM has a patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}