Small Fiber Polyneuropathy Is Prevalent in Patients Experiencing Complex Chronic Pelvic Pain

Annie Chen, Elise De, Charles Argoff, Charles E. Argoff
Pain medicine (Malden, Mass.) · 2018 · vol. 20(3) , pp. 521–527 · doi:10.1093/pm/pny001 · PMID:29447372 · W2791622393
article OA: closed CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that small fiber polyneuropathy (SFPN) was present in 64% of complex chronic pelvic pain patients referred to specialty clinics, suggesting SFPN is a significant factor in this population.

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Abstract

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.

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Condition tags

mesh:D017699endometriosischronic_pelvic_paininterstitial_cystitisirritable_bowel_syndrome

MeSH descriptors

Pelvic Pain Polyneuropathies Adult Chronic Pain Chronic Pain Female Humans Male Middle Aged Pelvic Pain Polyneuropathies Prevalence Retrospective Studies

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References (25)

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