Small Nerve Fibres in Idiopathic and Chemotherapy-Induced Neuropathy
Research type
Research Study
Full title
Defining Small Fibre Neuropathy and Neuropathic Pain in Idiopathic Small Fibre Neuropathy and Chemotherapy-Induced Peripheral Neuropathy
IRAS ID
256856
Contact name
Uazman Alam
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Summary of Research
Idiopathic small fibre neuropathy (ISFN) is a condition in which nerve damage to the small nerve fibres which conduct pain can lead to intractable neuropathic pain (which is the type of pain felt due to nerve damage). Chemotherapy-induced peripheral neuropathy (CIPN) can be a severe side effect of chemotherapy and has a high prevalence after chemotherapy administration. Currently, skin biopsy is considered the reference standard for the assessment of small fibre nerve damage. However, corneal confocal microscopy (CCM) has been extensively used to identify small nerve fibre damage in numerous conditions that affect the peripheral nervous system. Furthermore, people with small nerve fibre damage and neuropathic pain show greater corneal nerve loss. Thus far corneal confocal microscopy has shown huge potential in accurately identifying patients with small fibre nerve damage.We hypothesise that the non-invasive real-time ocular imaging technique of corneal confocal microscopy can detect damage to the small nerve fibres (which are the same type of nerve fibres that conduct pain) as accurately as skin biopsy. We also hypothesise that damage detected in small nerve fibres by corneal confocal microscopy and skin biopsy are related to the types of pain felt.
Nineteen healthy-volunteer controls, nineteen people with ISFN and nineteen people with CIPN will undergo detailed evaluation of neuropathic pain and small nerve fibre function and structure with follow up at one year to monitor progression.
Summary of Results
People with idiopathic neuropathy (nerve damage in the hands and feet without is clear reason) had sharp, stabbing, and spreading pain in their hands and feet. When we examined them, they found clear evidence of nerve damage, and the participants’ pain questionnaires showed that their symptoms were severe and bothersome. Tests of sensation showed that these individuals had a reduced ability to feel temperature, touch, and pinprick.As part of the study, the researchers also carried out an analysis using skin biopsies. We took small samples of skin and we also used two different lab techniques to stain the small nerve fibres within the skin. Both methods gave similar results, and they matched the standard laboratory manual method very closely.
Skin samples taken from the thigh and foot showed that participants had lost many of the small nerve fibres that normally allow us to feel pain, temperature, and light touch. A similar loss of nerves was also found in the cornea (the clear part at the front of the eye). Every participant with painful idiopathic neuropathy showed measurable nerve loss in either the skin or the cornea.
Overall, the results suggest that Idiopathic neuropathy is painful and involves significant damage to small nerves, which can be detected in the cornea, as well as the skin.
REC name
North West - Preston Research Ethics Committee
REC reference
19/NW/0078
Date of REC Opinion
20 May 2019
REC opinion
Further Information Favourable Opinion