Prevalence and determinants of pain in chronic inflammatory demyelinating polyneuropathy: Results from the German INHIBIT registry

Abstract

Background and purpose Pain, fatigue and depression in chronic inflammatory demyelinating polyneuropathy (CIDP) are often underestimated, as the focus lies on sensorimotor dysfunction and gait instability. The aim of this study was to investigate their prevalence, characteristics and contribution to disability in a prospective cohort of 84 patients with CIDP. Methods Pain, fatigue, depression and quality of life were measured using the Pain Detect Questionnaire, Krupp's Fatigue Severity Scale, Beck Depression Inventory II and the German Short‐Form 36 Health Survey. Sensorimotor deficits and disability were assessed using the Inflammatory Neuropathy Cause and Treatment overall disability score, the Rasch‐built Overall Disability Scale, the Medical Research Council sum score and the Inflammatory Neuropathy Cause and Treatment sensory sum score. The interrelation between the five factors was assessed using analysis of variance and linear regression analysis. Results Pain was reported in 62%, mostly of moderate and severe intensity, whereas pain characteristics indicated neuropathic pain (NP) in 29%. Sensory dysfunction was stronger in NP patients compared to pain‐free patients (p = 0.001). Pain of any type, especially NP, was associated with more pronounced fatigue symptoms (p = 0.010). Depressive symptoms were more frequent in patients with pain compared to the pain‐free patients (61% vs. 33%, p = 0.02) and were more severe and frequent in NP than in non‐NP patients (p = 0.005). Patients with pain had a worse physical quality of life than pain‐free patients (p = 0.001). Conclusion Pain, depression and fatigue are relevant disability factors in CIDP affecting quality of life. Sensory dysfunction is associated with NP. Therefore, evaluation of CIDP‐related disability should include pain and sensory function for adequate monitoring of therapeutic interventions.

Small fibre integrity and axonal pathology in the rat model of experimental autoimmune neuritis

“…On the other hand, our group has conducted a prospective registry study and showed that almost 50% of CIDP patients present with neuropathic pain indicative of hyperesthesia. 33 Therefore, small fibre involvement is evident in human and animal immune–mediated neuropathies, probably depending on the form and chronicity of the disease.…”

Enlarged cross-sectional area of the left vagus nerve in patients with major depressive disorder

“…The VNs were also found to be enlarged in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) ( 17 , 19 ). Interestingly, patients with CIDP may also show a subtle affection of the ANS with focus on parasympathetic cardiovascular fibers ( 20 ), and they may suffer from neuropsychiatric symptoms and disorders like pain, fatigue, and depression ( 21 , 22 ). However, so far depressive symptoms in patients with inflammatory polyneuropathies are thought to be reactive due to the patients’ functional impairment and not to be related to the inflammation of the peripheral nervous system or the VN ( 21 ).…”

What Is in the Literature

“…From a cohort of 84 patients who fulfilled EFNS/PNS criteria for CIDP, 45% with typical and 55% with atypical (DADS, MADSAM/LSS) pain was assessed by the Pain Detect Questionnaire, fatigue by the Krupp Fatigue Severity Scale, depression by the Beck Depression Inventory II, and quality of life by the SF-36. 14 Pain was described in 62% of patients with 52% as moderate in severity and 33% as severe, and neuropathic type pain was described in 46%, with no differences in frequency and type of pain between typical and atypical forms of CIDP. Factors related to the prevalence of pain were more sensory abnormalities but not degree of weakness; factors associated with pain were worse physical quality of life domain of the SF-36, greater fatigue scores, and more common depressive symptoms.…”