Theme 3 | Rare diseases

A Biopsychological Approach in Small Fiber Neuropathy: Insights from Focus Groups. 

Aysun Damci

Aysun Damci MD1,2,3, Janneke G.J. Hoeijmakers, MD, PhD1,2, Jeroen de Jong3,4, PhD, Ingemar S.J. Merkies1,6 MD, PhD, Catharina G. Faber, MD, PhD1,2, Jeanine A.M.C.F. Verbunt, MD, PhD3,4,5, Mariëlle E.J.B. Goossens, PhD3,4

1MHeNS, School for Mental Health and Neuroscience, Maastricht University, The Netherlands, 2Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands, 3Care and Public Health Research Institute, Maastricht university, The Netherlands, 4Department of Rehabilitation Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands, 5Adelante zorggroep, Center of Rehabilitation Medicine, Hoensbroek, The Netherlands, 6St. Elisabeth Hospital, Willemstad, Curacao.

Small fiber neuropathy (SFN) is characterized by severe chronic neuropathic pain and autonomic dysfunction (1). Unfortunately, current pharmacological treatment is insufficient (2,3). Chronic (neuropathic) pain is influenced by psychological factors, such as cognition, mood, disability and future perspectives. In various chronic pain conditions, patients report catastrophic thoughts about disease course and pain related disability. Catastrophizing, pain-related fear and disability influence quality of life (4-8). Insight into the psychological factors that play a role in SFN is needed. With this knowledge a targeted psychological therapy could be developed. The aim of the present study is to gain in-depth information about the psychological factors and other factors influencing health-related quality of life, such as cognition, mood, disability and future perspectives in patients with SFN. 

Four semi-structured qualitative focus group interviews were conducted with SFN patients (N = 15). Interviews were transcribed, coded and analyzed. 

Results show that patients tend to think in terms of catastrophes and based on these negative expectations, have started to adapt their daily lives to the pain. As a result, more limitations and less quality of life are experienced. However, the way in which limitations, negative thoughts and feelings are handled is different. Fear, especially for the future, was the most striking psychological topic. 

Given the results, it can be concluded that a treatment that considers both biological, psychological and social components is indicated. This will be taken into consideration in future research.

Pain, neuropathy, qualitative research

(1) Sopacua M, Hoeijmakers JGJ, Merkies ISJ, Lauria G, Waxman SG, Faber CG. Small-fiber neuropathy: Expanding the clinical pain universe. J Peripher Nerv Syst. 2018.
(2) Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-73.
(3) Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010;150(3):573-81.
(4) Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17(1):52-64.
(5) Severeijns R, Vlaeyen JW, van den Hout MA, Weber WE. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain. 2001;17(2):165-72.
(6) Bakkers M, Faber CG, Hoeijmakers JG, Lauria G, Merkies IS. Small fibers, large impact: quality of life in small-fiber neuropathy. Muscle Nerve. 2014;49(3):329-36.
(7) Lucey BP, Clifford DB, Creighton J, Edwards RR, McArthur JC, Haythornthwaite J. Relationship of depression and catastrophizing to pain, disability, and medication adherence in patients with HIV-associated sensory neuropathy. AIDS Care. 2011;23(8):921-8.
(8) Sullivan MJ, Lynch ME, Clark AJ. Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain. 2005;113(3):310-5.

The School for Mental Health and Neuroscience (MHeNs) strives to advance our understanding of brain-behaviour relationships by using an approach integrating various disciplines in neuro- and behavioural science, medicine, and the life sciences more widely. MHeNs performs high-impact mental health and neuroscience research and educates master's students and PhD researchers. MHeNs performs translational research, meaning practical collaboration between researchers in the lab and in the hospital. MHeNs is one of six graduate schools of the Faculty of Health, Medicine and Life Sciences (FHML) aligned to the Maastricht University Medical Centre+ (MUMC+).