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Small Fiber Neuropathy in Fibromyalgia & Chronic Fatigue Syndrome


Updated July 01, 2014

Small Fiber Neuropathy in Fibromyalgia & Chronic Fatigue Syndrome

Is the pain we feel with fibromyalgia and chronic fatigue syndrome a type of neuropathy? It's an idea that's been around for several years but is garnering wider support as researchers find more evidence.

Research just presented at the American Academy of Neurology's annual meeting suggests that many of us with these conditions have small fiber neuropathy -- abnormalities in the small nerve fibers, which are near the surface of your skin a deal with pain and temperature sensation.

Researchers took skin biopsies from 30 people with fibromyalgia, chronic fatigue syndrome, chronic pain syndrome, or a combination of these illnesses, as well as from a control group.  Of the people with painful conditions, 13 (43%) had evidence of small fiber neuropathy.

Dr. Devanshi Gupta, the lead researcher, says doctors should check for small fiber neuropathy via skin biopsies in patients who have:

  • Sharp, shooting pains
  • Orthostatic hypotension
  • Autonomic symptoms
  • Skin changes related to interrupted nerve supply
  • Incontinence
  • Sexual dysfunction
  • Or other neuropathic symptoms

However, another doctor stated that skin biopsies aren't reliable enough alone and should only be used to confirm a diagnosis based on examination and history.

I'm happy to see more evidence mounting to support the theory that these conditions, or at least a large subgroup of them, are neuropathic.  The prevalence of intense nerve pain, strange nerve sensations and abnormal nerve response all point that direction, as does the fact that many of us are helped by treatments aimed at neuropathy. Checking for small fiber neuropathy may help doctors determine which of us are likely to respond to neuropathy treatments.

So if this research is accurate and just under half of us have this type of neuropathy, what does that mean for the rest of us?  That's something that'll need to be explored further, but that exploration will be much simpler if they can exclude the subgroup with small fiber neuropathy.  We know we're not all alike, and the more we can be accurately subgrouped, the sooner we'll be able to find real answers to our many questions.

Do you have the symptoms Dr. Gupta attributes to small fiber neuropathy? Has a doctor ever suggested that to you or given you a skin biopsy for it? Do neuropathy treatments work for you? Leave your comments below!

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