High prevalence of perineural cysts in patients with fibromyalgia and Chronic Fatigue Syndrome, by Mieke Hulens, Frans Bruyninckx, Wim Dankaerts, Ricky Rasschaert, Peter De Mulder, Ingeborg Stalmans, Greet Vansant, Chris Bervoets in Pain Medicine, 1 Dec 2020 pnaa410 [doi.org/10.1093/pm/pnaa410]
Research abstract
Objective:
Pain in fibromyalgia (FM) and chronic fatigue syndrome (CFS) is assumed to originate from central sensitization. Perineural cysts or Tarlov cysts (TCs) are nerve root dilations resulting from pathologically increased cerebrospinal fluid pressure. These cysts initially affect sensory neurons and axons in dorsal root ganglia and produce sensory symptoms (pain and paresthesia). Symptomatic TC (STC) patients often complain about widespread pain and fatigue. Consequently, STC patients may initially be diagnosed with FM, CFS, or both. The objective of this study was to document the prevalence of TCs in patients diagnosed with FM or CFS.
Design:
A retrospective study.
Setting:
An outpatient clinic for musculoskeletal disorders.
Subjects:
Patients diagnosed with FM according to the 1990 American College of Rheumatology criteria or with CFS according to the 1994 Centers for Disease Control criteria were selected.
Methods:
Review of lumbar and sacral magnetic resonance imaging scans including TCs ≥5 mm in size.
Results:
In total, 197 patients with FM, CFS, or both underwent magnetic resonance imaging. Ninety-one percent were women. The mean age was 48.1 (±11.9) years. TCs were observed in 39% of patients, with a mean size of 11.8 (±5.2) mm. In males, the prevalence was 12%, vs. 42% in females.
Conclusions:
In patients diagnosed with FM or CFS, the prevalence of TCs was three times higher than that in the general population. This observation supports the hypothesis that STCs, FM, and CFS may share the same pathophysiological mechanism, i.e., moderately increased cerebrospinal fluid pressure, causing irritation of neurons and axons in dorsal root ganglia.
