Understanding Pain in Lupus
A recent review article underscores the importance of effective pain management in the treatment of lupus, emphasizing the need for accurate diagnosis of pain, treatment for the primary source of the pain, and careful monitoring of pain progression. Research demonstrates that pain experienced by people with lupus is complex and often presents as a frustrating cycle, in which initial pain triggers a different type of pain, which triggers still another type of pain.
Primary pain is caused by systemic (whole-body) inflammation. Lupus causes a pronounced activation of B cells (types of white blood cells involved in the immune system) and they produce several types of antibodies, all of which cause tissue damage in different parts of the body. This inflammatory process causes chronic pain.
In turn, persistent pain also affects the nervous system, resulting in “neuroinflammation”, which can alter regions of the brain, impact the spinal cord and damage nerves. This secondary neuroinflammation can trigger more localized inflammatory responses, like swelling, rashes, tenderness and increased pain in different parts of the body and cause abnormally heightened sensitivity to pain.
Additional factors can affect perceptions of pain from one person to the next. An individual’s genes may determine how sensitive one is to pain, while additional psychosocial considerations, like depression, anxiety, social support and environment can also mediate pain perception. While depression is strongly associated with increased feelings of pain, anxiety may either reduce or amplify pain sensitivity. Meanwhile, having strong social networks is widely observed to help increase pain coping behaviors and decrease perceived pain, though having a partner who is especially concerned about pain may actually predict higher levels of reported pain.
Although the experience of pain – and the risk factors associated with pain – is variable, pain itself is an almost universal symptom for people with lupus. It can affect quality of life not only during flares, but in times of mild to moderate disease activity, too. Understanding how, why and where pain occurs is essential to identify effective therapies. Learn about strategies for managing pain.