Whitman Wyatt, Sandberg Maxwell, Lee Peyton, Walker Stephen J
Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, United States.
Wake Forest School of Medicine, Institute for Regenerative Medicine, Winston Salem, NC, United States.
Front Urol. 2023 Feb 16;3:1098294. doi: 10.3389/fruro.2023.1098294. eCollection 2023.
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease that, based on the variable efficacy observed with most therapeutic options, is difficult to treat effectively. A more targeted patient selection process for current and emerging therapeutic options would likely help to improve outcomes. This narrative review explores small fiber polyneuropathy (SFPN) in IC/BPS as part of a larger widespread pain phenotype and as a potential therapeutic target. Because SFPN is becoming increasingly implicated in polysyndromic pain disorders (e.g., IC/BPS, chronic pelvic pain, and fibromyalgia) in which immune dysregulation is a suspected pathophysiologic etiology, continued consideration should be given to immunomodulatory therapies such as intravenous immunoglobulin (IVIg). Moreover, since the small fibers affected in SFPN continue to grow even as people age, targeted treatment may prevent further destruction and provide long-term benefits as the fibers are given time to repair. In addition to therapeutic potential, having a definitive SFPN diagnosis may provide psychological benefit in a patient population for which symptoms have historically been attributed to negative psychological factors. Finally, based on emerging data in this area, we propose consideration be given to include SFPN testing in the work-up of patients with IC/BPS that are refractory to treatments or have multiple comorbid pain syndromes since it may be an indicator of the need for alternative therapies. We believe that SFPN will play an increasingly larger role in the clinical evaluation and management of polysyndromic pain disorders, including IC/BPS.
间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种使人衰弱的慢性疾病，鉴于大多数治疗方案的疗效参差不齐，难以得到有效治疗。针对现有及新出现的治疗方案进行更有针对性的患者选择过程可能有助于改善治疗效果。这篇叙述性综述探讨了IC/BPS中的小纤维多发性神经病（SFPN），它是更广泛的广泛性疼痛表型的一部分，也是一个潜在的治疗靶点。由于SFPN越来越多地与多综合征性疼痛障碍（如IC/BPS、慢性盆腔疼痛和纤维肌痛）相关，而免疫失调被怀疑是其病理生理病因，因此应继续考虑免疫调节疗法，如静脉注射免疫球蛋白（IVIg）。此外，由于即使随着年龄增长，SFPN中受影响的小纤维仍会继续生长，靶向治疗可能会防止进一步破坏，并在纤维有时间修复时带来长期益处。除了治疗潜力外，对于一个症状历来被归因于负面心理因素的患者群体，明确诊断SFPN可能会带来心理益处。最后，基于该领域的新数据，我们建议考虑在对治疗难治或患有多种合并疼痛综合征的IC/BPS患者的检查中纳入SFPN检测，因为它可能是需要替代疗法的一个指标。我们相信，SFPN在包括IC/BPS在内的多综合征性疼痛障碍的临床评估和管理中将发挥越来越大的作用。
