Patients' pain experience in claudication: Biopsychosocial correlates of frequency, intensity, sleep interference,...

Pain is the hallmark symptom of claudication, the early stage of peripheral artery disease (PAD), yet its relationship with psychological distress remains unclear. We described pain patterns and examined its association with PAD severity and psychological factors in 1263 patients initiating PAD care using the PORTRAIT registry (16 vascular centers in the U.S., the Netherlands, and Australia, 06/2011-12/2015). Pain was assessed using the Peripheral Artery Questionnaire as frequent (≥daily), intense (moderate-to-extreme), sleep-interfering (nightly), and chronic based on pain duration >6 months. PAD severity markers included resting ankle-brachial index (ABI) and Rutherford stage. Psychological factors included depressive symptoms (Patient Health Questionnaire-8; PHQ-8), anxiety (Generalized Anxiety Disorder 2-item), and perceived stress (4-item Perceived Stress Scale). Hierarchical logistic regression models estimated odds ratios (Ors) with 95% confidence interval adjusted for PAD severity, sociodemographic, and comorbidities, with psychological factors added separately. Over 80% of patients reported heightened pain, with most experiencing frequent (72.5%), intense (63.3%), or chronic pain (67.2%), while 10.8% reported sleep-interfering. Psychological factors were associated with increased likelihood of frequent, intense, and sleep-interfering pain (ORs range: 1.58-5.09) regardless of age, sex, and country. Depressive symptoms emerged as the strongest pain correlate, surpassing traditional ischemic markers. While advanced Rutherford stage (stages 2 and 3 vs. 1) was associated with more frequent and intense pain (ORs range:1.59-2.65), resting ABI showed no significant association with pain characteristics. These findings highlight that pain burden in claudication reflects both vascular and psychological dimensions, underscoring the need for integrated biopsychosocial assessment beyond traditional hemodynamic measures in claudication. PERSPECTIVE: Pain in claudication is strongly correlated with depressive symptoms, moderately with advanced Rutherford stage, and not with ankle-brachial index. Recognizing this complex interplay highlights the need for integrated care strategies that go beyond hemodynamic measures, addressing mental health alongside physical symptoms to improve outcomes for patients with peripheral artery disease.