Bay-Smidt Charlotte N, Bruun Karin D, Gaist Laura M, Krøigård Anne B, Sindrup Søren H, Krøigård Thomas
Department of Neurology, Odense University Hospital, Odense, Denmark.
Pain Research Centre, Odense University Hospital, Odense, Denmark.
Eur J Neurol. 2025 Sep;32(9):e70349. doi: 10.1111/ene.70349.
Fibromyalgia (FM) is a complex chronic pain disorder characterized by widespread musculoskeletal pain and symptoms suggesting autonomic dysfunction. Small fiber neuropathy (SFN) has been described in a subgroup of patients. We aimed to explore the value of structured symptom assessment to identify patients with SFN or autonomic neuropathy.
Forty-six female FM patients were assessed in a cross-sectional study including clinical examinations, validated questionnaires (modified neuropathic pain symptom inventory (m-NPSI), PainDETECT and the composite autonomic symptom score (COMPASS 31)) and diagnostic tests (intraepidermal nerve fiber density (IENFD), quantitative sensory testing (QST) and quantitative sudomotor axon reflex test (QSART)). m-NPSI > 58, PainDETECT > 18, and COMPASS 31 > 16 were defined as suggestive of neuropathic pain and dysautonomia, respectively. SFN was defined as negative findings (hypoalgesia and reduced thermal sensation) and an abnormal diagnostic test (IENFD, thermal detection thresholds or QSART). Cardiovascular autonomic neuropathy (CAN) was defined as two abnormal cardiovascular reflex tests. Symptom scores were compared with patient controls and patients with an established diagnosis of neuropathy.
Among FM patients, one had SFN, while two had definite CAN. Thirty-two, 20, and 43 of the FM patients had NPSI, PainDETECT, and COMPASS 31 scores suggesting neuropathy/dysautonomia. NPSI was higher in FM than in neuropathy patients. Increased mechanical pain sensitivity (15/46) and paradoxical heat sensation (23/46) were frequent QST findings in the FM group.
SFN or autonomic neuropathy was infrequent in FM patients and not related to symptom scores, which were higher than those for patients with neuropathy.
纤维肌痛（FM）是一种复杂的慢性疼痛疾病，其特征为广泛的肌肉骨骼疼痛以及提示自主神经功能障碍的症状。在一部分患者中已发现存在小纤维神经病变（SFN）。我们旨在探讨结构化症状评估对识别SFN或自主神经病变患者的价值。
在一项横断面研究中，对46名女性FM患者进行了评估，包括临床检查、经过验证的问卷（改良的神经病理性疼痛症状量表（m-NPSI）、疼痛检测量表（PainDETECT）和复合自主神经症状评分量表（COMPASS 31））以及诊断测试（表皮内神经纤维密度（IENFD）、定量感觉测试（QST）和定量汗腺轴突反射测试（QSART））。m-NPSI > 58、PainDETECT > 18以及COMPASS 31 > 16分别被定义为提示神经病理性疼痛和自主神经功能障碍。SFN被定义为存在阴性结果（痛觉减退和热感觉减退）以及异常的诊断测试结果（IENFD、热检测阈值或QSART）。心血管自主神经病变（CAN）被定义为两项心血管反射测试异常。将症状评分与患者对照组以及已确诊神经病变的患者进行比较。
在FM患者中，1例患有SFN，2例患有确诊的CAN。32例、20例和43例FM患者的NPSI、PainDETECT和COMPASS 31评分提示存在神经病变/自主神经功能障碍。FM患者的NPSI高于神经病变患者。机械性疼痛敏感性增加（15/46）和矛盾性热感觉（23/46）是FM组中常见的QST结果。
FM患者中SFN或自主神经病变并不常见，且与症状评分无关，FM患者的症状评分高于神经病变患者。
