Baka Panoraia, Segelcke Daniel, Birklein Frank, Pogatzki-Zahn Esther M, Bigalke Stephan, Süer Ayşenur, Dugas Martin, Steenken Livia, Sommer Claudia, Papagianni Aikaterini
Department of Neurology, University Hospital Mainz, Mainz, Germany.
Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Germany.
Pain. 2024 Dec 1;165(12):2840-2850. doi: 10.1097/j.pain.0000000000003300. Epub 2024 Jun 28.
Pruritus often escapes physicians' attention in patients with peripheral neuropathy (PNP). Here we aimed to characterize neuropathic pruritus in a cohort of 191 patients with PNP (large, mixed, or small fiber) and 57 control subjects with deep phenotyping in a multicenter cross-sectional observational study at 3 German sites. All participants underwent thorough neurological examination, nerve conduction studies, quantitative sensory testing, and skin biopsies to assess intraepidermal nerve fiber density. Patients filled in a set of questionnaires assessing the characteristics of pruritus and pain, the presence of depression and anxiety, and quality of life. Based on the severity of pruritus and pain, patients were grouped into 4 groups: "pruritus," "pain," "pruritus and pain," and "no pruritus/no pain." Although 11% (21/191) of patients reported pruritus as their only symptom, further 34.6% (66/191) reported pruritus and pain. Patients with pain (with or without pruritus) were more affected by anxiety, depression, and reduced quality of life than control subjects. Patients with pruritus (with and without pain) had increases in cold detection threshold, showing Aδ-fiber dysfunction. The pruritus group had lower intraepidermal nerve fiber density at the thigh, concomitant with a more proximal distribution of symptoms compared with the other PNP groups. Stratification of patients with PNP by using cross-sectional datasets and multinominal logistic regression analysis revealed distinct patterns for the patient groups. Together, our study sheds light on the presence of neuropathic pruritus in patients with PNP and its relationship with neuropathic pain, outlines the sensory and structural abnormalities associated with neuropathic pruritus, and highlights its impact on anxiety levels.
瘙痒症在周围神经病变（PNP）患者中常常被医生忽视。在一项多中心横断面观察性研究中，我们旨在对191例PNP患者（大、混合或小纤维型）和57例对照受试者进行深度表型分析，以明确神经病理性瘙痒的特征，该研究在德国的3个地点开展。所有参与者均接受了全面的神经系统检查、神经传导研究、定量感觉测试和皮肤活检，以评估表皮内神经纤维密度。患者填写了一系列问卷，评估瘙痒和疼痛的特征、抑郁和焦虑的存在情况以及生活质量。根据瘙痒和疼痛的严重程度，患者被分为4组：“瘙痒”、“疼痛”、“瘙痒和疼痛”以及“无瘙痒/无疼痛”。虽然11%（21/191）的患者报告瘙痒是其唯一症状，但另有34.6%（66/191）的患者报告有瘙痒和疼痛。有疼痛（无论有无瘙痒）的患者比对照受试者更容易受到焦虑、抑郁和生活质量下降的影响。有瘙痒（无论有无疼痛）的患者冷觉检测阈值升高，表明Aδ纤维功能障碍。瘙痒组大腿处的表皮内神经纤维密度较低，与其他PNP组相比，症状分布更靠近近端。通过使用横断面数据集和多项逻辑回归分析对PNP患者进行分层，揭示了不同患者组的独特模式。总之，我们的研究揭示了PNP患者中神经病理性瘙痒的存在及其与神经病理性疼痛的关系，概述了与神经病理性瘙痒相关的感觉和结构异常，并强调了其对焦虑水平的影响。
