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Marshall A, Rapteas L, Burgess J, Riley D, Anson M, Matsumoto K, Bennett A, Kaye S, Marshall A, Dunham J, Fallon N, Zhao SS, Pritchard A, Goodson N, Malik RA, Goebel A, Frank B, Alam U. Small fibre pathology, small fibre symptoms and pain in fibromyalgia syndrome. Sci Rep 2024; 14:3947. [PMID: 38365860 PMCID: PMC10873371 DOI: 10.1038/s41598-024-54365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
A proportion of people with fibromyalgia demonstrate small fibre pathology (SFP). However, it is unclear how SFP directly relates to pain phenomenology. Thirty-three individuals with FMS and ten healthy volunteers underwent assessment of SFP and sensory phenotyping using corneal confocal microscopy, validated questionnaires and quantitative sensory testing (QST). Corneal nerve fibre length was used to stratify participants with fibromyalgia into with SFP [SFP+] and without SFP [SFP-]. SFP was detected in 50% of the fibromyalgia cohort. Current pain score and QST parameters did not differ between SFP+ and SFP-. Mechanical pain sensitivity (MPS) demonstrated a significant gain-of-function in the SFP- cohort compared to healthy-volunteers (p = 0.014, F = 4.806, η2 = 0.22). Further stratification revealed a cohort without structural SFP but with symptoms compatible with small fibre neuropathy symptoms and a significant gain in function in MPS (p = 0.020 Chi-square). Additionally, this cohort reported higher scores for both depression (p = 0.039, H = 8.483, η2 = 0.312) and anxiety (p = 0.022, F = 3.587, η2 = 0.293). This study confirms that SFP is present in a proportion of people with fibromyalgia. We also show that in a proportion of people with fibromyalgia, small fibre neuropathy symptoms are present in the absence of structural SFP. Greater mechanical pain sensitivity, depression and anxiety are seen in these individuals.
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Affiliation(s)
- Anne Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Leandros Rapteas
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Jamie Burgess
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - David Riley
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Matthew Anson
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Kohei Matsumoto
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Amanda Bennett
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Stephen Kaye
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - James Dunham
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Nicholas Fallon
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sizheng S Zhao
- Faculty of Biological Medicine and Health, Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Anne Pritchard
- Fibromates, North West Fibromyalgia Support Group, Liverpool, UK
| | - Nicola Goodson
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, 24144, Doha, Qatar
| | - Andreas Goebel
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Bernhard Frank
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Uazman Alam
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK.
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