Pain Experience and Learned Helplessness in Women with Primary Sjögren's Syndrome and Women with Fibromyalgia: A Descriptive and Comparative Study

Abstract

Objective. To describe the experience of pain and learned helplessness in women with primary Sjögren's syndrome [prim SS], to compare the experiences with those of women with fibromyalgia syndrome [FMS] and to investigate the prevalence of FMS in a random sample from a cohort of prim SS patients.

Methods. Forty-three patients with prim SS, also examined for FMS according to the American College of Rheumatology 1990 [ACR-90] criteria, and 44 patients with FMS completed a questionnaire including the Short-Form McGill Pain Questionnaire [SF-MPQ], a body map for pain drawing, Arthritis Helplessness Index [AHI], and questions about pain fluctuation, drug use, and functional status.

Results. Thirty-six [84 percent] of the prim SS patients experienced pain and eight [19 percent] also fulfilled the ACR-criteria for FMS. The patients with prim SS and pain experienced lower pain intensity than the FMS patients according to the intensity scores included in SF-MPQ, i.e., visual analog scale [P = 0.016], present pain intensity [P = 0.004] and intensity of the pain descriptors [P < 0.001]. The prim SS patients also used fewer pain descriptors [P < 0.001] and had a lower pain drawing score [P < 0.001] than the FMS patients. No differences were seen in AHI, pain fluctuation, and functional status. The pain distribution differed between the groups with a tendency to a more central distribution in patients with FMS and a more peripheral distribution in those with prim SS. The eight subjects fulfilling the ACR-90 criteria for FMS had similiar results for pain assessments as the pure FMS group.

Conclusion. The study suggests an increased prevalence of FMS and the presence of [at least] two patterns of pain in prim SS patients, one that is similiar to FMS and another that is less intensive and has a tendency to a more peripheral distribution. The therapeutic approach may differ in the two subgroups.

KEYWORDS:

• Sjögrens's syndrome
• fibromyalgia
• pain
• learned helplessness