Determinants of Pain, Disability, and QoL in Chronic Inflammatory Demyelinating Polyneuropathy

Patients with chronic inflammatory demyelinating polyneuropathy (CIDP) should be evaluated for pain, depression, and fatigue as these factors affect quality of life (QoL). These findings were published in the European Journal of Neurology.

Patients (N=84) with CIDP were recruited at the Ruhr-University Bochum in Germany in 2019 for the Immune-mediated Neuropathies Biomaterial and Data Register. Patients underwent clinical and electrophysiological assessments and were evaluated for pain, fatigue, depression, and QoL.

Patients had a median age of 55.0 at disease onset, 64 were male (range, 11.0-81.0), 68.7% were using immunoglobulins, 29.8% took pain medication, 26.5% used steroids, 54.5% had very severe axonal damage, and 34.5% had comorbidities. Most patients (61.9%) reported symptoms of pain. Patients with pain had a longer duration of disease, more used immunoglobulin and pain medications, and fewer had moderate axonal damage.

Pain was associated with more sensory abnormalities (P =.002), poorer QoL (P =.0001), fatigue (P =.044), more pronounced symptoms of fatigue (P =.04), depression (P =.02), and more severe symptoms of depression (P =.043).

Among patients with pain, 46.2% had neuropathic pain, 26.9% had uncertainty of neuropathic pain, and 26.9% nonneuropathic pain. Patients with neuropathic pain more often reported sensory loss (P =.001), they had worse fatigue symptomology (P =.010), and more severe depression symptomology (P =.025).

Pain intensity was related with QoL (R², 0.285), fatigue (R², 0.182), sensibility (R², 0.18), depression (R², 0.134), and disability (R², 0.053). Neuropathic pain was related with comorbidities (R², 0.208), QoL (R², 0.186), fatigue (R², 0.15), and axonal damage (R², 0.072).

This study may have been limited by not stratifying patients by active and stable disease stages or by treatment strategies.

The study authors observed that among patients with CIDP, pain of any type, but particularly neuropathic pain, was a relevant factor in disease sequelae. These symptoms were interrelated with symptoms of depression and fatigue, and ultimately disability and QoL.

Symptomatic treatment options are available for pain and symptoms of depression and should be considered among patients with these symptoms.

“Future research should focus on longitudinal assessment of the subgroup of painful CIDP through different stages of the disease and investigate possible specific ´sensory´ inflammatory and degenerative mechanisms,” the study authors noted.

Reference

Mork H Motte J, Fisse AL, et al. Prevalence and determinants of pain in chronic inflammatory demyelinating polyneuropathy: Results from the German INHIBIT registry. Eur J Neurol. Published online March 31, 2022. doi:10.1111/ene.15341

This article originally appeared on Clinical Pain Advisor