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Updated: Jun 8, 2025
Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
Pain and small fiber pathology in men with fibromyalgia syndrome
Betty Feulner1, Franziska Gross1, Dimitar Evdokimov1
1Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
Introduction:
Small fiber pathology may be involved in the pathophysiology of pain in women with fibromyalgia syndrome (FMS).
Objectives:
This prospective single-center case-control study provides detailed pain phenotyping and small fiber pathology data in a cohort of men with FMS on a morphological and functional level.
Methods:
Forty-two men with FMS underwent a comprehensive pain-related interview and neurological examination, a questionnaire and neurophysiological assessment, and specialized small fiber tests: skin punch biopsy, quantitative sensory testing including C-tactile afferents, and corneal confocal microscopy. Data were compared with those of healthy male controls.
Results:
Men with FMS reported generalized and permanent pain with additional pain attacks and a mostly pressing pain character. Intraepidermal nerve fiber density was reduced at ≥1 biopsy site in 35 of 42 (83%) men with FMS (controls: 32/65, 49%). Compared with male controls, men with FMS had elevated cold (P < 0.05) and warm detection thresholds (P < 0.001) and an increased mechanical pain threshold (P < 0.05) as well as an impairment of C-tactile afferents (P < 0.05). Corneal nerve fiber density was lower in male patients with FMS vs healthy men (P < 0.01). Male FMS patients with pathological skin innervation at ≥1 biopsy site compared with those with normal skin innervation had a higher clinical Widespread Pain Index (P < 0.05) indicating an association between the severity of cutaneous denervation and symptom load.
Conclusion:
We show a distinct pain phenotype and small nerve fiber dysfunction and pathology in male patients with FMS. These findings may have implications for the diagnosis and management of men with FMS.
Insights
Men with fibromyalgia syndrome (FMS) exhibit distinct small nerve fiber pathology and pain phenotypes. This research highlights potential diagnostic and management implications for male FMS patients.
Area of Science:
- Neurology
- Pain Medicine
- Pathology
Background:
- Small fiber pathology is implicated in fibromyalgia syndrome (FMS) pain, primarily studied in women.
- Understanding FMS pathophysiology in men requires specific investigation into pain presentation and nerve fiber integrity.
Purpose of the Study:
- To investigate pain phenotypes and small fiber pathology in men with FMS.
- To compare morphological and functional small fiber data between male FMS patients and healthy controls.
Main Methods:
- Prospective case-control study involving 42 men with FMS and healthy male controls.
- Utilized comprehensive pain assessment, neurological examination, and specialized tests: skin biopsy, quantitative sensory testing, and corneal confocal microscopy.
Main Results:
- 83% of men with FMS showed reduced intraepidermal nerve fiber density.
- Male FMS patients displayed altered sensory thresholds (cold, warm, mechanical pain) and impaired C-tactile afferents.
- Corneal nerve fiber density was reduced, and skin denervation correlated with widespread pain severity.
Conclusions:
- Distinct pain phenotypes and small nerve fiber pathology are evident in male FMS patients.
- Findings suggest potential avenues for improved diagnosis and management strategies for men with FMS.
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