Small Fiber Polyneuropathy common in CPPS pts

[webslave]

Pain Med. 2018 Feb 13. doi: 10.1093/pm/pny001. [Epub ahead of print]
Small Fiber Polyneuropathy Is Prevalent in Patients Experiencing Complex Chronic Pelvic Pain.
Chen A1, De E2, Argoff C3.
1 Department of Urology, Albany Medical Center, Albany, New York.
2 Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.
3 Department of Neurology, Albany Medical College, Albany, New York, USA.

Objective: To demonstrate the prevalence of small fiber polyneuropathy (SFPN) in patients with refractory chronic pelvic pain (CPP).
Design: Retrospective study of prospective database.

Subjects: Participants were complex CPP patients recruited from subspecity referral clinics defined as those who were refractory to initial treatment and/or exhibited comorbid pain syndromes at initial presentation.

Methods: Comprehensive treatment history for CPP was obtained, and participants referred as above; 3-mm punch biopsies were obtained of the lower extremity and sent to diagnostic reference labs to evaluate for SFPN. The reported lab sensitivity and specificity for SFPN are 78-92% and 65-90%, respectively.

Results: Twenty-five of 39 patients (64%) were positive for SFPN. Comorbid conditions noted in our population included gastroesophageal reflux disease (46%), migraine (38%), irritable bowel syndrome (33%), lower back pain (33%), fibromyalgia (38%), endometriosis (15%), interstitial cystitis (18%), vulvodynia (5%), and other chronic pain syndromes (36%).

Conclusions: The prevalence of SFPN in our specialty referral patients with complex CPP is remarkably high vs published general population prevalence data (53/100,000). Identification of SFPN in this complex population shifts the focus from undefined syndromes to symptom complexes with linked potentially treatable mechanisms (e.g., SFPN, central sensitization). Most CPP patients with SFPN are undiagnosed. Considering the diagnosis may expand treatment options beyond conventional or so-called adjuvant analgesics. Treatment may expand to therapies such as IV lidocaine, IVIG, or other immunomodulatory options. In addition, the value to the patient of receiving a diagnosis for a multisystem or refractory pain syndrome, often attributed to negative psychologic factors, cannot be underestimated. Identifying SFPN should be contemplated in CPP patients who present with multisystem pain or who have not responded to initial evaluation and management.

PMID: 29447372

[Joe02324]

Thanks for the post. Was recently diagnosed by a neurologist with SFN as a cause for the pelvic issues. Different docs have all diagnosed me with different explanations for the pelvic issues (e.g. prostatitis, narrow bladder neck, anxiety..etc) .. but I believe the SFN might be correct in my case as I have other sx that seem to fit the diagnosis (e.g. tingling in hands and feet). The diagnosis was based of current sx and excluding others with conventional tests--but still have not had a skin punch to actually confirm it-- but again, i'm leaning towards it and will seek further tests to confirm.

Webslave-- If this is the case then would it still be useful to keep seeking relief through Wise-Anderson methods or are you pretty much left with treating it with drugs? My guess is that the WA/ Quercetin wouldn't be much help in my case.

[webslave]

If you have confirmed SFPN then you need to try IV lidocaine and other treatments.

Pointless discussing this until you've got it confirmed via punch biopsy.