Department of Urology, Albany Medical Center, Albany, New York.
Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.
Pain Med. 2019 Mar 1;20(3):521-527. doi: 10.1093/pm/pny001.
To demonstrate the prevalence of small fiber polyneuropathy (SFPN) in patients with refractory chronic pelvic pain (CPP).
Retrospective study of prospective database.
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.
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.
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%).
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.
展示难治性慢性盆腔疼痛（CPP）患者中小纤维多神经病（SFPN）的患病率。
前瞻性数据库的回顾性研究。
从专科转介诊所招募的复杂 CPP 患者为研究对象，这些患者被定义为对初始治疗有抵抗力的患者，或在初始表现时出现合并疼痛综合征的患者。
获取 CPP 的综合治疗史，并转介上述患者；对下肢进行 3 毫米活检，并送到诊断参考实验室，以评估 SFPN。SFPN 的报告实验室灵敏度和特异性分别为 78-92%和 65-90%。
39 名患者中有 25 名（64%）SFPN 阳性。在我们的人群中，注意到的合并病症包括胃食管反流病（46%）、偏头痛（38%）、肠易激综合征（33%）、下腰痛（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%）和其他慢性疼痛综合征（36%）。
与已发表的一般人群患病率数据（53/100,000）相比，我们的专科转介复杂 CPP 患者中 SFPN 的患病率非常高。在这种复杂人群中识别 SFPN 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综合征（例如，SFPN，中枢敏化）。大多数有 SFPN 的 CPP 患者未被诊断。考虑到诊断可以扩大治疗选择范围，超出常规或所谓的辅助镇痛药。治疗可能扩展到 IV 利多卡因、IVIG 或其他免疫调节治疗等。此外，对于经常归因于负面心理因素的多系统或难治性疼痛综合征的患者，收到诊断的价值不可低估。对于出现多系统疼痛或对初始评估和治疗无反应的 CPP 患者，应考虑 SFPN。
