[Neuropathic pain as a symptom in autonomic neuropathies and other rare diseases : Small fiber neuropathy: its recognition, diagnosis, and treatment].

IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Schmerz Pub Date : 2024-02-01 Epub Date: 2024-01-10 DOI:10.1007/s00482-023-00783-w
Fiona Fischer, Maike F Dohrn, Romina Kapfenberger, Denver Igharo, Diana Seeber, Elena de Moya Rubio, Kalliopi Pitarokoili, Natalie Börsch, Martin Mücke, Roman Rolke, Jörg B Schulz, Andrea Maier
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Abstract

Background: Neuropathic pain is difficult to diagnose and treat. Small fiber neuropathy (SFN) flies under the radar of nerve conduction studies.

Objectives: The importance of a structured patient history and physical examination in the context of neuropathic pain is emphasized. Describing SFN as an important cause, the authors consider rare but partially treatable differential diagnoses. They conclude that autonomic symptoms are frequently associated, often presenting with diverse symptoms.

Methods: A selective literature research to present SFN symptoms as well as differential diagnostic and therapeutic steps in the context of SFN and rare diseases focusing on the autonomic nervous system.

Results: Neuropathic pain significantly reduces quality of life. To shorten the time until diagnosis and to initiate therapy, the authors recommend a structured patient history including sensory plus and minus symptoms and non-specific autonomic signs. If the initial search for the cause is not successful, rare causes such as treatable transthyretin (ATTR) amyloidosis and Fabry's disease or autoimmune causes should be considered, particularly in the case of progressive and/or autonomic symptoms.

Conclusion: The diagnosis and therapy of rare SFN requires interdisciplinary collaboration and, in many cases, a referral to specialized centers to achieve the best patient care.

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[作为自律神经病和其他罕见疾病症状的神经性疼痛:小纤维神经病:其识别、诊断和治疗]。
背景:神经病理性疼痛难以诊断和治疗。小纤维神经病变(SFN)在神经传导研究中被忽视:作者强调了结构化病史和体格检查在神经病理性疼痛中的重要性。作者将 SFN 描述为一个重要病因,并考虑了罕见但可部分治疗的鉴别诊断。他们的结论是,自律神经症状经常与多种症状相关联:方法:通过选择性文献研究,介绍 SFN 症状以及在 SFN 和罕见疾病背景下的鉴别诊断和治疗步骤,重点关注自律神经系统:神经病理性疼痛大大降低了生活质量。为了缩短诊断和开始治疗的时间,作者建议对患者病史进行结构化分析,包括感觉症状和非特异性自律神经体征。如果最初寻找病因未果,应考虑可治疗的转甲状腺素(ATTR)淀粉样变性和法布里病等罕见病因或自身免疫性病因,尤其是在出现进行性和/或自主神经症状的情况下:罕见 SFN 的诊断和治疗需要跨学科合作,在许多情况下还需要转诊到专业中心,以获得最佳的患者护理。
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来源期刊
Schmerz
Schmerz 医学-临床神经学
CiteScore
2.00
自引率
20.00%
发文量
64
审稿时长
6-12 weeks
期刊介绍: Der Schmerz is an internationally recognized journal and addresses all scientists, practitioners and psychologists, dealing with the treatment of pain patients or working in pain research. The aim of the journal is to enhance the treatment of pain patients in the long run. Review articles provide an overview on selected topics and offer the reader a summary of current findings from all fields of pain research, pain management and pain symptom management. Freely submitted original papers allow the presentation of important clinical studies and serve the scientific exchange. Case reports feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. Review articles under the rubric ''Continuing Medical Education'' present verified results of scientific research and their integration into daily practice.
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