Prevalence of multidisciplinary symptoms in patients with small fiber neuropathy

Background and Objective Small fiber neuropathy (SFN) is a neurological condition which can lead to somatic pain and autonomic dysfunction. Injury to the peripheral nerves predominantly impacts thinly myelinated A-Delta and unmyelinated C fibers. We explored whether patients presenting with SFN versus those without reported a higher prevalence of pelvic concerns: urinary, defecatory, sexual, and pelvic pain symptoms, as well as systemic autonomic and chronic overlapping pain syndromes. Methods 259 patients completed the comprehensive multidisciplinary electronic intake for our subspecialty adult Urology/Urogynecology and Reconstructive Pelvic Surgery/Multidisciplinary Pelvic Pain clinic and underwent in person evaluation. We used validated measures and non-validated autonomic and neurological symptom tallies to characterize symptomatology. Subsequently, patients with indication for workup for SFN (e.g. unexplained chronic overlapping pain syndromes or multiple autonomic symptoms with negative EMG) underwent skin biopsy of the lateral calf seeking abnormal epidermal nerve fiber density and sweat glands. Statistical analysis included descriptive statistics and unpaired t-tests were used to compare pelvic symptoms in those found to have SFN versus those without biopsy-confirmed SFN. Key Findings and Limitations Presence of SFN was strongly associated with urinary symptoms, prolapse symptoms, genitourinary pain, pain in the last 30 days, sexual function (in women), intensity of orgasm​, pain with intercourse, autonomic symptoms, neuro-urological symptoms, depression and anxiety, and reduced quality of life even within a subspecialty pelvic health population​. Limitations include focus on a sub-specialty patient population with a common chief complaint of chronic pelvic pain, retrospective review of the ultimate SFN diagnosis, and the fact that biopsy for SFN was performed only on those with indications, not the entire population. Conclusions and Clinical Implications SFN is associated with a high prevalence of pelvic and systemic symptoms, a finding relevant to pelvic health specialists in this exploratory study. Pelvic health specialists are front-line for patients with SFN due to pelvic organ impact of dysfunction of the autonomic nerves and somatic pain fibers. Patients presenting with multi-system pelvic symptomatology, autonomic symptoms, and chronic overlapping pain conditions such as interstitial cystitis, migraine, fibromyalgia, dizziness, hearing changes, and anxiety should be considered for referral to a neurologist with expertise in autonomic dysfunction for evaluation for SFN and other neurological etiologies.