Small fibre pathology, small fibre symptoms and pain in fibromyalgia syndrome.

K Matsumoto, J Dunham, N Goodson, RA Malik, A Goebel

Research output: Contribution to journalArticle (Academic Journal)peer-review


A proportion of people with fibromyalgia demonstrate small fibre pathology (SFP). However, it is unclear how SFP directly relates to pain phenomenology. Thirty-three individuals with FMS and ten healthy volunteers underwent assessment of SFP and sensory phenotyping using corneal confocal microscopy, validated questionnaires and quantitative sensory testing (QST). Corneal nerve fibre length was used to stratify participants with fibromyalgia into with SFP [SFP+] and without SFP [SFP-]. SFP was detected in 50% of the fibromyalgia cohort. Current pain score and QST parameters did not differ between SFP+ and SFP-. Mechanical pain sensitivity (MPS) demonstrated a significant gain-of-function in the SFP- cohort compared to healthy-volunteers (p = 0.014, F = 4.806, η2 = 0.22). Further stratification revealed a cohort without structural SFP but with symptoms compatible with small fibre neuropathy symptoms and a significant gain in function in MPS (p = 0.020 Chi-square). Additionally, this cohort reported higher scores for both depression (p = 0.039, H = 8.483, η2 = 0.312) and anxiety (p = 0.022, F = 3.587, η2 = 0.293). This study confirms that SFP is present in a proportion of people with fibromyalgia. We also show that in a proportion of people with fibromyalgia, small fibre neuropathy symptoms are present in the absence of structural SFP. Greater mechanical pain sensitivity, depression and anxiety are seen in these individuals.
Original languageUndefined/Unknown
Article number3947
JournalScientific Reports
Issue number1
Publication statusPublished - 16 Feb 2024

Bibliographical note

Funding Information:
The authors acknowledge funding by Versus Arthritis (Grant Number 22471) for this study (DEFINE-FMS). SSZ is supported by a National Institute for Health Research Clinical Lectureship and works in centres supported by Versus Arthritis (Grant Nos. 21173, 21754 and 21755). With kind appreciation to Fibromates patient support group for their input throughout the study.

Publisher Copyright:
© The Author(s) 2024.

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