Hava Özlem DEDE, Bahar Özdemir ULUSOY, Mehmet Akif EKSİN
Neurological Sciences and Neurophysiology - 2026;43(3):139-145
Objective: Neuropathic pain is a frequent and disabling manifestation of Sjögren syndrome (SS); however, the relative contributions of peripheral small-fiber dysfunction and central sensitization remain unclear. This study evaluated electrophysiologic markers of small-fiber function and central sensitization-related symptom burden in patients with SS with and without neuropathic pain. Methods: In this prospective study, patients with SS were classified according to neuropathic pain status using the Neuropathic Pain Questionnaire and compared with healthy controls. All participants underwent nerve conduction studies and cutaneous silent period (CSP) recordings. Systemic disease activity was assessed using the SS Disease Activity Index (ESSDAI), and central sensitization-related symptom burden using the Central Sensitization Inventory (CSI). Psychological status and quality of life were assessed using the Hospital Anxiety and Depression Scale and Short Form-36. Multivariate logistic regression analysis was performed. Results: CSI scores were significantly higher in patients with neuropathic pain and emerged as the only independent predictor in multivariate analysis ( P = 0.005). CSP onset latency was prolonged in patients with SS, indicating small-fiber dysfunction, whereas CSP duration did not differ significantly between groups. Neuropathic pain was not independently associated with CSP parameters or ESSDAI scores. Both SS subgroups exhibited significantly reduced sural sensory nerve action potential amplitudes compared with healthy controls ( P < 0.001). Conclusions: Peripheral small-fiber dysfunction alone appears insufficient to explain neuropathic pain in SS. Central sensitization-related symptom burden was more strongly associated with neuropathic pain, highlighting the importance of multidimensional pain assessment integrating electrophysiologic and patient-reported measures.
