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Pain Pract. 2019 Apr;19(4):426-434. doi: 10.1111/papr.12763. Epub 2019 Feb 6.

The Clinical Features of Painful Small-Fiber Neuropathy Suggesting an Origin Linked to Primary Sjögren's Syndrome.

Author information

1
EA 4391, Faculty of Medicine, Paris-Est-Creteil University, Créteil, France.
2
Physiological Investigations, Habib Bourguiba University Hospital, Sfax, Tunisia.
3
Neurology Department, Henri Mondor University Hospital, AP-HP, Creteil, France.
4
Physiological Investigations & Sport Medicine, Avicenne Hospital, AP-HP, Bobign, France.
5
EA 2363, UFR SMBH, Paris_13 University, Bobigny, France.
6
Internal Medicine Department, Lariboisiere Hospital, AP-HP, Paris-7 University, Paris, France.
7
Clinical Neurophysiology, Henri Mondor University Hospital, AP-HP, Créteil, France.

Abstract

OBJECTIVE:

We attempted to determine whether clinical features could differentiate painful small-fiber neuropathy related to primary Sj€ogren's syndrome (pSS-SFN) from idiopathic SFN (idio-SFN).

METHODS:

Validated clinical questionnaires and neurophysiological investigations specific for pain and SFN assessment were performed in 25 patients with pSS-SFN and 25 patients with idio-SFN.

RESULTS:

Patients with idio-SFN had more frequent severe burning sensations and higher mean anxiety scores and daily pain intensity compared to patients with pSSSFN. Conversely, patients with pSS-SFN had reduced electrochemical skin conductance measured by Sudoscan_, and almost half of them had the sensation of walking on cotton wool.

CONCLUSION:

Our results suggest that idio-SFN more specifically involved small sensory fibers than pSS-SFN, in which subtle dysfunction of larger sensory fibers and damage of distal autonomic sudomotor innervation may occur. A practical algorithm is proposed to help to differentiate SFN associated with pSS from idio-SFN, based on information very easy to obtain by clinical interview.

KEYWORDS:

clinical neurophysiology; pain descriptors; questionnaire; restless leg syndrome; sicca syndrome; skin conductance; small-fiber neuropathy

PMID:
30636091
DOI:
10.1111/papr.12763
[Indexed for MEDLINE]

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