Falco Pietro, Galosi Eleonora, Di Stefano Giulia, Leone Caterina, Di Pietro Giuseppe, Tramontana Lorenzo, De Stefano Gianfranco, Litewczuk Daniel, Esposito Nicoletta, Truini Andrea
Department of Human Neuroscience, Sapienza University, Rome, Italy.
J Pain. 2024 Jan;25(1):64-72. doi: 10.1016/j.jpain.2023.07.020. Epub 2023 Jul 29.
In this clinical and skin biopsy study, we aimed to investigate whether fibromyalgia-associated small-fiber pathology (SFP), consisting of an intraepidermal nerve fiber loss, implies damage of dermal autonomic nerve fibers and how this damage is associated with autonomic symptoms that patients with fibromyalgia syndrome experience. Using skin biopsy, we investigated intraepidermal nerve fiber density, piloerector muscle, and sweat gland nerve fiber density (SGNFD) in 138 participants, that is, 58 patients with fibromyalgia syndrome, 48 healthy subjects, and 32 patients with small-fiber neuropathy. In patients with fibromyalgia-associated SFP, we also investigated how the different skin biopsy variables correlated with autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 questionnaire. We found that in patients with fibromyalgia-associated SFP, the piloerector muscle and SGNFD were lower than that in healthy subjects. However, the autonomic small-fiber damage had no correlation with autonomic symptoms severity. In patients with SFP, the intraepidermal, piloerector muscle, and SGNFD were higher than that in patients with small-fiber neuropathy. Our clinical and skin biopsy study shows that patients with fibromyalgia have a reduction of dermal autonomic small fibers paralleling the intraepidermal nerve fiber loss, thus indicating that SFP also implies autonomic small nerve fiber damage. However, the autonomic small-fiber damage we found had no correlation with the severity of autonomic symptoms, and thus its clinical impact is still undetermined. PERSPECTIVE: In patients with fibromyalgia, SFP also affects autonomic fibers. These novel data provide additional insights into the pathophysiology of fibromyalgia syndrome, highlighting the complex role of small-fiber damage in the clinical picture of fibromyalgia.
在这项临床与皮肤活检研究中，我们旨在调查由表皮内神经纤维缺失构成的纤维肌痛相关小纤维病理改变（SFP）是否意味着真皮自主神经纤维受损，以及这种损伤如何与纤维肌痛综合征患者所经历的自主神经症状相关联。我们采用皮肤活检，对138名参与者的表皮内神经纤维密度、竖毛肌以及汗腺神经纤维密度（SGNFD）进行了研究，这138名参与者包括58例纤维肌痛综合征患者、48名健康受试者以及32例小纤维神经病变患者。在患有纤维肌痛相关SFP的患者中，我们还研究了不同的皮肤活检变量如何与自主神经症状相关，自主神经症状通过综合自主神经症状评分31问卷进行评估。我们发现，在患有纤维肌痛相关SFP的患者中，竖毛肌和SGNFD低于健康受试者。然而，自主神经小纤维损伤与自主神经症状严重程度并无关联。在患有SFP的患者中，表皮内、竖毛肌以及SGNFD高于小纤维神经病变患者。我们的临床与皮肤活检研究表明，纤维肌痛患者的真皮自主小纤维减少，与表皮内神经纤维缺失并行，因此表明SFP也意味着自主神经小纤维损伤。然而，我们发现的自主神经小纤维损伤与自主神经症状的严重程度并无关联，因此其临床影响仍未确定。观点：在纤维肌痛患者中，SFP也会影响自主神经纤维。这些新数据为纤维肌痛综合征的病理生理学提供了更多见解，突出了小纤维损伤在纤维肌痛临床表现中的复杂作用。
