Sural Nerve Size in Fibromyalgia Syndrome: Study on Variables Associated With Cross-Sectional Area

Journal of Neuroimaging

Bianchi

Cipolletta

et al. 2023

Self Cite

Background and Purpose Although fibromyalgia (FM) is considered a central sensitization syndrome, studies investigating peripheral nerves in this condition are not available. The primary objective of this study is to investigate the sonographic changes (ie, increased cross‐sectional area [CSA]), of peripheral nerves in patients with FM compared to healthy controls. The secondary objective is to identify potential clinical correlations associated with increased CSA in patients with FM. Methods In this cross‐sectional observational study, consecutive female patients with FM underwent sonographic assessment using a standardized scanning protocol. The CSA of seven nerves was measured bilaterally at 11 anatomic sites by an experienced sonographer. Differences in CSA of nerves were compared with those of healthy subjects by one‐way analysis of variance. Patients underwent clinimetric evaluation aimed at investigating disease severity, neuropathic pain features, depression, anxiety, fatigue, and autonomic symptoms to explore the possible correlation between CSA and clinical features. Results Forty‐seven patients and 20 healthy controls were enrolled. Differences in terms of increased CSA between patients and healthy controls were identified at multiple levels, mainly at the level of the sural nerve, vagus nerve, and sixth cervical nerve root (for all, p < .001). Sonographic findings, however, did not correlate with the clinical features explored. Conclusions Patients with FM show higher CSA of nerves than healthy subjects. The increased CSA is most evident at the sural nerve, vagus nerve, and sixth cervical nerve root. Ultrasound, a relatively easy‐to‐use technique, could identify morphological changes, in peripheral nervous structures in patients with FM.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imaging of the peripheral nervous system in nociplastic pain: An ultrasound study in patients with fibromyalgia

Journal of Neuroimaging

Bianchi

Cipolletta

et al. 2023

Self Cite

“…In patients with fibromyalgia, the pathophysiology is still to be clarified, and, however, there are not only central sensitization mechanisms as explanation for painful symptoms. A segment of the literature of recent years has documented how, in about half of patients, there is a small fiber neuropathy [62], documented as reduced intraepidermal nerve fiber density (IENFD) with techniques such as histological examination on skin biopsy or corneal confocal microscopy [63,64], more recently alternative diagnostic modalities such as ultrasound of the sural nerve have been sought [65,66]. The presence of a reduced IENFD conceptually falls within the "neuropathic" domain, leading to doubt that the definition of nociplastic pain is applicable to all patients with fibromyalgia.…”

Section: Nociplastic Painmentioning

confidence: 99%

Mechanisms and Mediators of Pain in Chronic Inflammatory Arthritis

Curr Treat Options in Rheum

Smerilli

Salaffi

2021

Self Cite

Purpose of the review Pain in chronic inflammatory joint diseases is a common symptom reported by patients. Pain becomes of absolute clinical relevance especially when it becomes chronic, i.e., when it persists beyond normal healing times. As an operational definition, pain is defined chronic when it lasts for more than 3 months. This article aims to provide a review of the main mechanisms underlying pain in patients with chronic inflammatory joint diseases, discussing in particular their overlap. Recent findings While it may be intuitive how synovial inflammation or enthesitis are responsible for nociceptive pain, in clinical practice, it is common to find patients who continue to complain of symptoms despite optimal control of inflammation. In this kind of patients at the genesis of pain, there may be neuropathic or nociplastic mechanisms. Summary In the context of chronic inflammatory joint diseases, multiple mechanisms generally coexist behind chronic pain. It is the rheumatologist’s task to identify the mechanisms of pain that go beyond the nociceptive mechanisms, to adopt appropriate therapeutic strategies, including avoiding overtreatment of patients with immunosuppressive drugs. In this sense, future research will have to be oriented to search for biomarkers of non-inflammatory pain in patients with chronic inflammatory joint diseases.

“…It is believed, however, that FM is the prototype of diseases characterized by the presence of central sensitization [3]. In addition, a number of evidence have documented a potential involvement of the peripheral nervous system, de ned by the presence of a small sensory ber neuropathy [4,5]. Moreover, a recent study has hypothesised that FM may have an autoimmune basis.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture efficacy for fibromyalgia in the framework of predictive, preventive, and personalized medicine: results of a pragmatic open-label study

Beci

Cipolletta

et al. 2022

Preprint

Self Cite

Background. Acupuncture is an effective therapy in chronic pain that can be recommended in patients with fibromyalgia (FM). However, the symptomatological expressiveness of FM is very wide, and to date, there is no ideal patient who is a suitable candidate for acupuncture therapy. In a high-prevalence disease such as FM, in the absence of well-codified treatment patterns, being able to apply the rationale of predictive, preventive and personalized medicine (PPPM/3PM) is crucial to avoid unnecessary expense and burden on patients. The aim of this study, in the context of PPPM/3PM, is to identify the predictive factors of failure to acupuncture in order to identify the ideal FM patient to be directed to such treatment. Methods. FM patients with severe symptoms refractory to standard drug therapy underwent eight weekly acupuncture sessions. Significant improvement, defined as a reduction of at least 30% of the Revised Fibromyalgia Impact Questionnaire (FIQR), was assessed at the end of the eight weeks (T1) of treatment and three months after the end of treatment (T2). Univariate analysis was conducted to identify predictors of significant improvement at T1 and T2. Variables, which resulted significantly associated with clinical improvement at univariate analysis, were included in multivariate models. Results. Analyses were conducted on 77 patients (9 males, 11.7%). At T1, significant improvement in FIQR was recorded in 34 out of 77 patients (44.2%). At T2, significant improvement in FIQR persisted in 16 out of 77 patients (20.8%). In multivariate analysis, predictive variables of treatment failure were tender point count (odds ratio [OR] = 0.49, 95% confidence interval [95% CI]: 0.28–0.86, p = 0.01) and pain magnification (OR = 0.68, 95% CI: 0.47–0.99, p = 0.04) assessed with Pain Catastrophizing Scale, at T1. At T2, the only predictive variable of treatment failure was concomitant duloxetine use (OR = 0.21, 95% CI: 0.05–0.95, p = 0.04). Conclusion. The novelties of this study are in the context of PPPM/3PM in terms of a predictive approach, through the identification of clinical characteristics of unfavorable response to acupuncture. By evaluating these variables, it is possible to implement a targeted and cost-effective tertiary prevention and plan personalized medical service in patients with FM.