Pain and fatigue in systemic sclerosis: Practical strategies for non-pharmacological management.

Abstract

Objective: Pain and fatigue are among the most prevalent and disabling symptoms in patients with systemic sclerosis, significantly impairing quality of life and daily functioning. Despite their high burden, these symptoms are frequently underrecognized and undertreated by clinicians. This narrative review aims to synthesize current evidence and practical approaches to support multidisciplinary care in the assessment and non-pharmacological management of pain and fatigue in systemic sclerosis.

Methods: We conducted a comprehensive review of the literature focusing on the multifactorial causes, diagnostic workup, and non-pharmacological treatment strategies for pain and fatigue in systemic sclerosis. This narrative review integrates evidence-based recommendations, expert consensus statements, and reflects best current clinical practice.

Results: Pain and fatigue in patients with systemic sclerosis are underestimated and often multifactorial. Pain in systemic sclerosis may arise from musculoskeletal, neuropathic, vascular, gastrointestinal, and iatrogenic sources, while fatigue is driven by cardiopulmonary involvement, malnutrition, endocrine dysfunction, poor sleep quality, and psychological factors. Accurate symptom assessment requires a combination of patient-reported outcome measures, clinical examination, imaging modalities, and laboratory testing. Non-pharmacological interventions, including physical rehabilitation, cognitive behavioural therapy, nutritional support, and mind-body practices, demonstrate particularly promising benefits in symptom relief and functional improvement, although high-quality evidence in systemic sclerosis remains limited.

Conclusion: A personalized, holistic approach is essential to effectively address pain and fatigue in patients with systemic sclerosis. Interdisciplinary care involving rheumatologists, nurses, physiotherapists, nutritionists, psychologists, and occupational therapists is key to optimizing outcomes. Our data show that some unmet needs await to be addressed and therefore an agenda for future research is proposed to improve quality of life in patients with systemic sclerosis.