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Managing Hidradenitis Suppurativa and Chronic Pain

Managing your symptoms of HS can be challenging, even at the best of times. The painful skin symptoms of HS can be hard to treat and you may have pain elsewhere that is bothering you.

HS is a chronic inflammatory skin disease that begins when clogged hair follicles cause bumps. It can cause abscesses, inflammation, and painful skin lesions. Keeping your skin lesions under control might help with the immediate pain from HS. However, there is so much more to HS pain than that.

What is chronic pain?

There are 2 general categories of pain: acute and chronic. Acute pain is a normal body process that triggers your nervous system to alert you of possible injury. Acute pain is short-term and goes away.

Many people with HS describe their acute pain as burning, stinging, shooting, and stabbing. Usually, relief of acute pain comes only after the lesions rupture. People with HS may go to the emergency room or seek care from their dermatologist (skin specialist) for relief.1

Chronic pain is something totally different. Chronic pain persists long-term. The body responds to a suspected injury and is constantly triggered in chronic pain. This response may last weeks, months, or even years. This persistent body response to suspected injury causes long-term pain.

Chronic pain is linked with advanced HS disease. Many often describe it as an ongoing gnawing, aching tenderness, and throbbing. Other symptoms of chronic pain vary from person to person but may also include:1,2

  • Headache
  • Back pain
  • Joint pain
  • Muscle pain

Comorbidity, chronic pain, and HS

Doctors are still learning the exact causes of HS. Long-term irritation or inflammation within the body are thought to be major reasons why HS happens. In HS, this irritation signal inside the body is never turned off. This causes the body to show its irritation by the symptoms on the skin.

This irritation and inflammation inside the body causes other problems beside HS.

Doctors use the term comorbidity to describe a condition or illness that occurs at the same time of another condition or illness. Morbidity is not the same as mortality. Morbidity means disease or illness and mortality means death.3

There are several comorbid conditions in HS. Chronic pain is among these conditions and causes decreased quality of life for many with HS.

Mental distress in HS and the link to chronic pain

Chronic pain in HS is often complicated by the mental distress that HS causes. Depression and anxiety are common comorbidities in HS. The physical appearance of the skin in HS can lead to a negative self image. Also, the skin lesions in HS may smell bad, adding to the emotional impact of the disease.4

Your friends and family may not fully understand your disease. This can lead to feelings of embarrassment and isolation, which can make your chronic pain worse. Doctors may have a difficult time finding the right treatment plan for you. This is distressing and frustrating. Remember that talking to your doctor about your symptoms and concerns will help to find the best treatment options for you.

Depression and anxiety can worsen pain symptoms. Pain symptoms can worsen depression and anxiety. Because these conditions are closely linked, it may become a cycle that can be hard to break.

Types of chronic pain that occurs in HS

The severity of your HS symptoms does not have to reflect the severity of pain you are experiencing. In other words, even if your skin appears less irritated than usual, your pain may be worse.

You may have different types of chronic pain from HS. The first is the local pain of the skin lesions. Another type of pain may be joint or muscular pain. Both acute and chronic pain can interfere with sleep and activities of daily life.1,5

There are options for your pain. Talk to your doctor about your symptoms. It may take a few different medications or treatments, but managing your pain and your quality of life is a priority for your doctor. With persistence and time, you will hopefully find a treatment management that works best for you.

Written by: Katie Murphy | Last reviewed: December 2020
  1. Patel ZS, Hoffman LK, Buse DC, et al. Pain, psychological comorbidities, disability, and impaired quality of life in hidradenitis suppurativa. Curr Pain Headache Rep. 2017;21(12):49.
  2. Chronic Pain Information Page. National Institute for Neurological Disorders and Stroke. Available at https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Pain-information-Page. Accessed 8/24/2020.
  3. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357-363. doi:10.1370/afm.983.
  4. Vekic D, Gains G. The Royal Australian College of General Practitioners. 2017; 46(8): 584-588. Available at https://www.racgp.org.au/download/Documents/AFP/2017/August/AFP-2017-8-Clinical-Hidradenitis.pdf. Accessed 8/24/2020.
  5. Schnebert B, Del Marmol V, Benhadou F. Low Back Pain in Hidradenitis Suppurativa: A Diagnosis Not to Miss!. Case Rep Dermatol. 2018;10(2):187-189. doi:10.1159/000490880.