Small Fiber Polyneuropathy Is Prevalent in Patients Experiencing Complex Chronic Pelvic Pain
Small Fiber Polyneuropathy Is Prevalent in Patients Experiencing Complex Chronic Pelvic Pain
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DOI：
10.1093/pm/pny001
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发表时间：
2019-03-01
期刊：
影响因子：
3.1
通讯作者：
Argoff, Charles
中科院分区：
文献类型：
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作者：
Chen, Annie;De, Elise;Argoff, Charles
目的探讨难治性慢性盆腔疼痛（CPP）患者小纤维多发性神经病（SFPN）的患病率。方法收集10例难治性CPP患者的临床资料，采用回顾性前瞻性数据库研究方法。研究对象为难治性CPP患者。和上述参与者;从下肢获得3 mm穿孔活检，并送至诊断参考实验室以评估SFPN。结果39例患者中有25例（64%）SFPN阳性。在我们人群中观察到的共病包括胃食管反流病（46%）、偏头痛（38%）、肠易激综合征（33%）、下背痛（33%）、纤维肌痛（38%）、子宫内膜异位症（15%）、间质性膀胱炎（18%）、外阴痛（5%）、结论与已发表的一般人群患病率数据（53/100，000）相比，我们的专科转诊复杂CPP患者中SFPN的患病率非常高。在这个复杂人群中识别SVPN将焦点从未定义的综合征转移到具有潜在可治疗机制的症状复合体（例如，SFPN，中枢致敏）。大多数CPP患者SFPN未确诊。考虑到诊断可能会扩大治疗选择超越传统或所谓的辅助镇痛药。治疗可以扩展到IV利多卡因，IVIG或其他免疫调节剂等治疗。此外，不能低估诊断为多系统或难治性疼痛综合征（通常归因于消极心理因素）的患者的价值。在出现多系统疼痛或对初始评估和治疗无反应的CPP患者中，应考虑识别SFPN。
Objective To demonstrate the prevalence of small fiber polyneuropathy (SFPN) in patients with refractory chronic pelvic pain (CPP).Design Retrospective study of prospective database.Subjects Participants were complex CPP patients recruited from subspecity referral clinics defined as those who were refractory to initial treatment and/or exhibited comorbid pain syndromes at initial presentation.Methods Comprehensive treatment history for CPP was obtained, and participants referred as above; 3-mm punch biopsies were obtained of the lower extremity and sent to diagnostic reference labs to evaluate for SFPN. The reported lab sensitivity and specificity for SFPN are 78-92% and 65-90%, respectively.Results Twenty-five of 39 patients (64%) were positive for SFPN. Comorbid conditions noted in our population included gastroesophageal reflux disease (46%), migraine (38%), irritable bowel syndrome (33%), lower back pain (33%), fibromyalgia (38%), endometriosis (15%), interstitial cystitis (18%), vulvodynia (5%), and other chronic pain syndromes (36%).Conclusions The prevalence of SFPN in our specialty referral patients with complex CPP is remarkably high vs published general population prevalence data (53/100,000). Identification of SFPN in this complex population shifts the focus from undefined syndromes to symptom complexes with linked potentially treatable mechanisms (e.g., SFPN, central sensitization). Most CPP patients with SFPN are undiagnosed. Considering the diagnosis may expand treatment options beyond conventional or so-called adjuvant analgesics. Treatment may expand to therapies such as IV lidocaine, IVIG, or other immunomodulatory options. In addition, the value to the patient of receiving a diagnosis for a multisystem or refractory pain syndrome, often attributed to negative psychologic factors, cannot be underestimated. Identifying SFPN should be contemplated in CPP patients who present with multisystem pain or who have not responded to initial evaluation and management.