Sommer Claudia, Üçeyler Nurcan
Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
Pain Rep. 2024 Dec 24;10(1):e1220. doi: 10.1097/PR9.0000000000001220. eCollection 2025 Feb.
About 50% of women with fibromyalgia syndrome have reduced skin innervation. This finding is consistent in patient cohorts from different regions of the world. Small fiber function may also be affected, as shown by various studies using different methods, such as quantitative sensory testing or special small fiber neurophysiology such as C-fiber microneurography. Microneurography in particular has shown increased spontaneous activity, mechanosensitivity, and enhanced activity-induced slowing in C fibers of patients with fibromyalgia. Generalized reduction of skin innervation, ie, proximally and distally, was associated with higher symptom severity and more pronounced central nervous system changes as seen in magnetic resonance tomography. The question whether peripheral or central nervous system changes come first, or whether both are signs of an underlying pathology, has not been resolved yet. For clinical practice, it is important to note that reduced skin innervation in fibromyalgia must not be confused with small fiber neuropathy, which is a separate entity with different characteristics and pathophysiology. Further prospective research is warranted to transfer these findings in the peripheral nervous system into clinical fibromyalgia patient management.
约50%的纤维肌痛综合征女性患者存在皮肤神经支配减少的情况。这一发现在来自世界不同地区的患者队列中是一致的。如使用不同方法（如定量感觉测试或特殊的小纤维神经生理学方法，如C纤维微神经ography）的各种研究所显示，小纤维功能也可能受到影响。特别是微神经ography显示，纤维肌痛患者的C纤维自发活动增加、机械敏感性增强以及活动诱导的减慢增强。皮肤神经支配的普遍减少，即近端和远端的减少，与更高的症状严重程度以及磁共振断层扫描中所见的更明显的中枢神经系统变化相关。外周或中枢神经系统变化哪个先出现，或者两者是否都是潜在病理的迹象，这个问题尚未得到解决。对于临床实践而言，重要的是要注意，纤维肌痛中皮肤神经支配减少绝不能与小纤维神经病变相混淆，小纤维神经病变是具有不同特征和病理生理学的独立疾病。有必要进行进一步的前瞻性研究，以便将这些在外周神经系统中的发现应用于纤维肌痛患者的临床管理。
