Impact of pain on quality of life (QoL) in patients with acromegaly: profound differences in physical and mental aspects of QoL

Headache and joint pain have been described as relevant factors for the disease-specific burden of acromegaly. We aimed to determine whether pain has a differential influence on physical and mental quality of life (QoL) in this patient group. 124 patients with acromegaly (age 18–79 years, median 59.0) from three tertiary endocrine and/or neurosurgical centers completed self-constructed questionnaires on acromegaly symptoms and pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). QoL was assessed with the Short Form (SF)-36. Overall, 65% (N = 81) of patients reported pain attributed to acromegaly, whereas 35% (N = 43) did not. These two groups differed in pain (z = -5.62, p < .001), stiffness (z = -4.05, p < .001) and physical activity (z = -5.91, p < .001), and pain during daily activities, with significantly greater impairments in patients reporting pain attributed to acromegaly. This group also exhibited a significantly worse QoL on the physical (z = -5.90, p < .001) and mental level (z = -2.68, p = .007), and a higher BMI (z = -3.16, p = .002). A predictive model showed that higher scores in WOMAC pain, any joint pain, higher age, and higher BMI were significantly associated with reduced physical QoL (72% explained variance). In contrast, mental QoL variability was explained to a much lesser extent (9%). The results show the differential effect of pain on physical and mental QoL, emphasizing that patients with acromegaly require not only routine assessment of pain but also adequate management of pain and associated symptoms.