Evaluation of the neuropathic component of pain in patients with fibromyalgia with painDETECT and DN4

Year 2024, Volume: 41 Issue: 2, 246 - 252, 19.05.2024

Ümit Seçil Demirdal , Özlem Küçülmez , Ayhan Aşkın , Aliye Tosun , Duygu Koçak

Abstract

Fibromyalgia (FMS) is generally associated with neuropathic pain (NP) because of the neuropathic symptoms frequently observed in patients with FMS. The aim of the study is to evaluate the neuropathic component of FMS with the painDETECT (PD-Q) and Douler Neuropathic 4 (DN4) scales. Female patients diagnosed as FMS according to the American College of Rheumatology’s 2010 FMS criteria and female healthy volunteers are included in the study. After demographic evaluation, the patients and volunteers were asked to fill out Visual Analog Score (VAS), PD-Q, and DN4 scale forms. The Fibromyalgia Impairment Questionnaire (FIQ) evaluated life quality and function. There were 66 patients in the FMS group with a mean age of 46.16± 10.66 and 61 patients in the control group with a mean age of 44.93± 12.72. It was determined that there was a significant difference between the VAS, PD-Q, and DN4 values of FMS and control groups (tVAS = 5,025 p < 0.05, t PD-Q = 5,025 p < 0.05, tDN4 = 7,885 p < 0.05). The mean pain score (VAS) and NP level (DN4 and PD-Q) of FMS patients were significantly higher than healthy individuals. In addition, it was determined that VAS (p = 0.001) and PD-Q (p = 0.046) values were found to be significant predictors of the FIQ values. FMS patients may have pain with a neuropathic component, and it seems useful to evaluate neuropathic characteristics with PD-Q and DN4. If the components of pain are researched carefully, more improvement may be achieved in pain and functional capacity.

Keywords

Chronic fatigue, fibromyalgia, fibromyalgia syndrome, neuropathic pain

Ethical Statement

We declare that we have no ethical problem, conflict of interest or financial interest in the current study. We declare that the article has not been previously published, all authors contribute the data in article and the data is totally original.

Supporting Institution

We did not have any support or funding during the study.

Project Number

0626

Thanks

Thank you for your time for evaluating this study. Acknowledgement: None

References

• Borchers AT, Gershwin ME. Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol 2015; 49(2):100-51.
• Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 2013; 17(8):356.
• Cheng CW, Wong CS, Hui GK, Chung EK, Wong SH. Fibromyalgia: is it a neuropathic pain? Pain Manag 2018; 8(5):377-388.
• Albrecht PJ, Rice FL. Fibromyalgia syndrome pathology and environmental influences on afflictions with medically unexplained symptoms. Rev Environ Health 2016; 31(2):281-94.
• Fleming KC, Volcheck MM. Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review. Rambam Maimonides Med J. 2015; 6(2):e0020.
• Attal N, Bouhassira D, Baron R. Diagnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol. 2018 May;17(5):456-466.
• Kösehasanoğullari M, Erdinç Gündüz N, Akalin E. Is Fibromyalgia Syndrome a Neuropathic Pain Syndrome? Arch Rheumatol 2018; 34(2):196-203.
• Martínez-Lavin M, López S, Medina M, Nava A. Use of the leeds assessment of neuropathic symptoms and signs question-naire in patients with fibromyalgia. Semin. Arthritis Rheum. 2003;32:407–411.
• Gauffin J, Hankama T, Kautiainen H, Hannonen P, Haanpää M. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study. BMC Neurol 2013; 13:21.
• Yaray O, Akesen B, Ocaklioğlu G, Aydinli U. Validation of the Turkish version of the visual analog scale spine score in patients with spinal fractures. Acta Orthop Traumatol Turc 2011; 45(5):353-8.
• Alkan H, Ardic F, Erdogan C, Sahin F, Sarsan A, Findikoglu G. Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study. Pain Med 2013;14(12):1933-43.
• Celik S, Yenidunya G, Temel E, Purisa S, Uzum AK, Gul N et al. Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus. Prim Care Diabetes 2016;10(4):259-64.
• Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int. 2000 Dec;20(1):9-12.
• Staud R. Cytokine and immune system abnormalities in fibromyalgia and other central sensitivity syndromes. Curr Rheumatol Rev 2015; 11(2):109-15.
• Kim J, Loggia ML, Cahalan CM, Harris RE, Beissner F Dr Phil Nat et al. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction. Arthritis Rheumatol 2015; 67(5):1395-1405.
• Fleming KC, Volcheck MM. Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review. Rambam Maimonides Med J 2015; 6(2):e0020.
• Ueda H. Systems Pathology of Neuropathic Pain and Fibromyalgia. Biol Pharm Bull 2019; 42(11):1773-1782.
• Koroschetz J, Rehm SE, Gockel U, Brosz M, Freynhagen R, Tölle TR et al. Fibromyalgia and neuropathic pain--differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia. BMC Neurol 2011; 11:55.
• Fishbain DA, Cole B, Lewis JE, Gao J. What is the evidence that neuropathic pain is present in chronic low back pain and soft tissue syndromes? An evidence-based structured review. Pain Med. 2014; 15(1):4-15.
• Kösehasanoğullari M, Erdinç Gündüz N, Akalin E. Is Fibromyalgia Syndrome a Neuropathic Pain Syndrome? Arch Rheumatol 2018; 34(2):196-203.
• Freynhagen R, Tölle TR, Gockel U, Baron R. The painDETECT project - far more than a screening tool on neuropathic pain. Curr Med Res Opin 2016; 32(6):1033-57.
• Di Carlo M, Cesaroni P, Salaffi F. Neuropathic pain features suggestive of small fibre neuropathy in fibromyalgia syndrome: a clinical and ultrasonographic study on female patients. Clin Exp Rheumatol 2021; 130(3):102-107.
• Amris K, Jespersen A, Bliddal H. Self-reported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds. Pain. 2010 Dec;151(3):664-669.
• Akaltun MS, Altindağ Ö, Akyol A, Göktürk H, Aydeni A, Gürsoy S et al. Neuropathic Pain and Its Relationship with Clinical Findings in Patients with Fibromyalgia. Noro Psikiyatr Ars 2020; 59(1):44-47.
• Martinez-Lavin M. Centralized nociplastic pain causing fibromyalgia: an emperor with no cloths? Clin Rheumatol 2022; 41(12):3915-3917.
• Momi SK, Fabiane SM, Lachance G, Livshits G, Williams FMK. Neuropathic pain as part of chronic widespread pain: environmental and genetic influences. Pain 2015; 156(10):2100-2106.
• Ubeda-D'Ocasar E, Valera-Calero JA, Gallego-Sendarrubias GM, Fernández-de-Las-Peñas C, Arias-Buría JL, Morales-Cabezas M et al. Association of Neuropathic Pain Symptoms with Sensitization Related Symptomatology in Women with Fibromyalgia. Biomedicines 2022; 10(3):612.
• Koçyiğit BF, Okyay RA. The relationship between body mass index and pain, disease activity, depression and anxiety in women with fibromyalgia. Peer 2018 May 28:6:e4917.7
• Mainka T, Maier C, Enax-Krumova EK. Neuropathic pain assessment: update on laboratory diagnostic tools. Curr Opin Anaesthesiol 2015; 28(5):537-45.
• Grayston R, Czanner G, Elhadd K, Goebel A, Frank B, Üçeyler N et al. A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis. Semin Arthritis Rheum 2019; 48(5):933-940.
• Dumolard A, Lefaucheur JP, Hodaj E, Liateni Z, Payen JF, Hodaj H. Central Sensitization and Small-fiber Neuropathy Are Associated in Patients With Fibromyalgia. Clin J Pain. 2023; 39(1):8-14.
• Kosmidis ML, Koutsogeorgopoulou L, Alexopoulos H, Mamali I, Vlachoyiannopoulos PG, Voulgarelis M et al. Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: a controlled study. J Neurol Sci 2014; 347(1-2):143-7.
• Linda Oudejans, Xuan He, Marieke Niesters, Albert Dahan, Michael Brines, Monique van Velzen. Cornea nerve fiber quantification and construction of phenotypes in patients with fibromyalgia. Sci Rep 2016; 6: 23573.