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Case Reports
. 2022 Dec;27(4):291-301.
doi: 10.1111/jns.12514. Epub 2022 Oct 7.

Anxiety and depression in small fiber neuropathy

Aysun Damci  1   2 , Koen R J Schruers  1   3 , Carsten Leue  1   3 , Catharina G Faber  1   2 , Janneke G J Hoeijmakers  1   2
Affiliations
Case Reports

Anxiety and depression in small fiber neuropathy

Aysun Damci et al. J Peripher Nerv Syst. 2022 Dec.

Abstract

Psychiatric comorbidity is common in patients with chronic pain. In peripheral neuropathic pain, particularly anxiety and mood disorders are frequently present and associated with a high level of catastrophizing. Small fiber neuropathy (SFN) is a peripheral neuropathy dominated by pain. This study aimed to investigate the prevalence of and factors associated with anxiety and depressive symptoms in SFN. All consecutive patients diagnosed with SFN at Maastricht University Medical Center+, between September 2016 and October 2021, were included (n = 1310). Data on demographics, medical history, diagnostic tests, and questionnaires about pain, SFN-specific symptoms, and mental health were collected once. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression and the Pain Catastrophizing Scale (PCS) to measure the degree of catastrophizing. One-third of the patients had an abnormal HADS score (≥11) on the subscales anxiety and/or depression (26.5% anxiety and 23.0% depression) indicating clinical relevance. Regression analysis showed that higher pain intensity, catastrophizing, and more SFN-related complaints were significantly associated with an abnormal HADS-score. In conclusion, the prevalence of reported anxiety or depressive symptoms in SFN is 36.3%. A multidisciplinary approach, not only focusing on pain relief, is therefore essential for the treatment of SFN.

Keywords: anxiety; association; depression; neuropathic pain; small fiber neuropathy.

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Conflict of interest statement

Dr. Damci, Dr. Schruers, and Dr. Leue declared no conflicts of interest. Dr. Faber reports grants from European Union's Horizon 2020 research and innovation programme Marie Sklodowska‐Curie grant for PAIN‐Net, Molecule‐to‐man pain network (grant no. 721841), grants from Grifols and Lamepro for a trial on IVIg in small fiber neuropathy, grants from Prinses Beatrix Spierfonds, Steering committees/advisory board for studies in small fiber neuropathy of Biogen/Convergence, Vertex, Lilly and OliPass, outside the submitted work. Dr. Hoeijmakers reports a grant from the Prinses Beatrix Spierfonds (W.OK17‐09). This work is generated within the European Reference Network for Neuromuscular Diseases.

Figures

FIGURE 1
FIGURE 1
Questionnaire about the pain locations. The figure is available in the online questionnaire for patients who had the diagnostic workup of SFN in the Maastricht UMC+. The following question is followed by this figure: “Could you indicate the locations where you experience the maximum pain intensity?”. It is possible for patients to indicate several pain locations.
FIGURE 2
FIGURE 2
Flowchart. In total 1608 patients were screened. 298 patients were excluded. Reasons for exclusion: not having a complete workup in the Maastricht UMC+ (N = 10), and not meeting the diagnostic criteria of SFN (N = 288). A total of 1310 patients were diagnosed with SFN according to the Besta criteria and included for further analysis.
FIGURE 3
FIGURE 3
Pearson correlations of HADS subscale anxiety with several outcomes. The outcome of HADS subscale anxiety (HADS‐A) was correlated with the following outcomes: age, the number of pain locations, the current pain intensity, the duration of SFN complaints, the PCS total score and the SFN‐SIQ centile metric score. Abbreviations: HADS‐A, HADS questionnaire subscale anxiety; PCS, pain catastrophizing scale; r, Pearson r coefficient; SFN, small fiber neuropathy; SFN‐SIQ, SFN related symptom inventory questionnaire.
FIGURE 4
FIGURE 4
Pearson correlations of HADS subscale depression with several outcomes. The outcome of HADS subscale depression (HADS‐D) was correlated with the following outcomes: age, the number of pain locations, the current pain intensity, the duration of SFN complaints, the PCS total score and the SFN‐SIQ centile metric score. Abbreviations: HADS‐A, HADS questionnaire subscale anxiety; PCS, pain catastrophizing scale; r, Pearson r coefficient; SFN, small fiber neuropathy; SFN‐SIQ, SFN related symptom inventory questionnaire.
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