Specific symptoms may discriminate between fibromyalgia patients with vs without objective test evidence of small-fiber polyneuropathy

Lodahl, Mette; Treister, Roi; Oaklander, Anne Louise

doi:10.1097/pr9.0000000000000633

Cited by 38 publications

(30 citation statements)

References 26 publications

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“…Nearly half of patients with fibromyalgia have evidence of reduced IENFD on skin biopsy, and emerging evidence indicates that nearly a third of patients have a distal large fiber neuropathy as indicated by low medial plantar responses 93. It is unclear whether patients who have fibromyalgia with and without small fiber pathology are clinically distinguishable,94 although some researchers report that paresthesia and autonomic involvement may predict the presence of small fiber dysfunction 95. One prospective study compared 30 patients with fibromyalgia with 34 age and sex matched healthy controls in terms of clinical examination, quantitative sensory testing, skin biopsy, blood and cutaneous miRNA isolation.…”

Section: Differential Diagnosis Of Small Fiber Neuropathiesmentioning

confidence: 99%

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Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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Section: Differential Diagnosis Of Small Fiber Neuropathiesmentioning

confidence: 99%

“…That said, the identification of the presence of small fiber dysfunction in fibromyalgia enables screening for other causes of SFN, such as diabetes 939597…”

Section: Differential Diagnosis Of Small Fiber Neuropathiesmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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“…11 Autonomic dysfunction could even be the common clustering of FM, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis, and underlie their pathogenesis. 12 Adelta and C nerve fibers, involved in painful and thermal perception, also innervate sweat glands that are linked to the autonomic nervous system, [13][14][15][16] and sweat gland innervation could be dysfunctional because of an alteration of these nerve fibers. Such a dysautonomia may be a detectable abnormality in diabetic SFN, 17 familial amyloid polyneuropathy, or Fabry's disease, 15,[18][19][20][21][22] and has been studied using an electrophysiological noninvasive tool (Sudoscan; Impeto Medical, Paris, France) that measures electrochemical skin conductance (ESC).…”

Section: Introductionmentioning

confidence: 99%

Electrochemical Skin Conductance and Quantitative Sensory Testing on Fibromyalgia

et al. 2019

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Background An impairment of the peripheral nervous system has been suggested in fibromyalgia (FM). Noninvasive distal electrochemical skin conductance (ESC) has been studied little so far when combined with quantitative sensory testing (QST) in patients with FM. Methods This study (clinicaltrials.gov NCT03347669) included 50 female patients with FM and 50 matched healthy volunteers (HVs). ESC (measured in microsiemens [µS] with Sudoscan), as well as psychological, quality of life, sleep, and social characteristics, were assessed in both groups. In a subgroup of 24 patients with FM and 24 HVs, QST of cold and warm detection and pain thresholds and diffuse noxious inhibitory controls (DNICs) were explored. Statistical analysis was performed for a 2‐sided type I error at 5%. Results Between patients with FM and HVs, ESC values differed (71.4 ± 11.2 µS vs. 74.4 ± 10.3 µS, respectively; P = 0.003), especially on the dominant hand (P = 0.03), where more patients with FM had ESC values < 66 µS than did HVs (P = 0.046). No difference was observed on feet. In patients with FM, all collected characteristics were impaired (P < 0.001), DNICs were less functional, detection thresholds occurred later, and pain thresholds occurred earlier. No correlation was observed between ESC and DNICs or with any parameter. Conclusion This study shows that the sudomotor function is significantly impaired in patients with FM, especially on the dominant hand. This occurs in parallel with adjustments of detection and pain thresholds in the context of deficient spinal pain modulation. ESC values combined with QST values are relevant in the context of patients with FM and need to be explored further in this nociception‐autonomic system intertwining.

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“…The patients reported that fatigue, reduced endurance, and cognitive concerns were bigger problems than tingling, numbness, and postural orthostatic tacycardia syndrome . Fibromyalgia shifted toward SFPN then SFPN shifted toward fibromyalgia …”

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confidence: 98%

“…15 Fibromyalgia shifted toward SFPN then SFPN shifted toward fibromyalgia. 16 To what extent do the names matter? As it turns out, names matter substantially.…”

mentioning

confidence: 99%