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Adrienne Dellwo

Small Fiber Neuropathy May Cause Fibromyalgia Pain

By March 27, 2013

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Research Brief

A small study has linked the pain of fibromyalgia to small nerve fiber neuropathy, which is painful damage to a certain part of a certain nerve. This could be a ground-breaking study, as fibromyalgia has previously been linked to nerve dysfunction, but not to actual nerve damage.

Researchers examined the small fibers in different areas of the body using three different methods: sensory testing, pain response, and skin biopsy. They compared them between people with fibromyalgia, those with depression, and healthy control subjects.

They determined that people with fibromyalgia had:

  • Impaired small fiber function that lead to increased temperature sensitivity;
  • Sensory irregularities in the feet, face, and hands;
  • Lower total nerve fibers and fewer regenerating nerve fibers in the skin;
  • Fewer unmyelinated nerve fiber bundles in the skin, but normal levels of myelinated nerve fibers.

Researchers concluded that all three testing methods support the idea of impaired small fiber function, and therefore a high likelihood of neuropathic pain, in fibromyalgia.

Understanding the Science

A quick lesson in neurology now, so that these findings make sense to you.

First, look at the picture above. The pink spots are neurons, the cells that make up nerves. The stringy things connecting them are called axons or fibers.

The fibers in the skin, organs, and peripheral nerves are called C fibers or small fibers. Their job is to provide sensation for your skin and to control autonomic function - all the automatic jobs your body does, like regulating heart rate, breathing, and body temperature. Damage to these nerves is called peripheral neuropathy.

Now let's look at the final finding listed above: Fewer unmyelinated nerve fiber bundles in the skin, but normal levels of myelinated nerve fibers.

Picture a large electronic cable cut in half. Inside, it contains a bunch of smaller cables that are bundled together and put inside a casing. Small fibers in your body are bundled in a similar way as they travel together away from nerve cells and toward the areas they serve.

Some of those bundles are in a protective casing called myelin, or a myelin sheath. The medical term for a sheathed bundle is myelinated.

Other bundles are "naked" - they don't get a myelin sheath. It's these naked, unmyelinated bundles that, according to this study, appear to be damaged in fibromyalgia. That could be an important clue to researchers as they try to uncover the reasons for the damage.

The Relevance

This could be an extremely important avenue of research. Doctors understand neuropathic pain. It's common in diabetes and as a result of nerve damage. It's a concrete explanation for our pain, which is currently classified as "poorly understood" or "idiopathic" (meaning without cause.)

Neuropathy in us makes sense. It explains why medications known to improve neuropathy, such as Lyrica (pregabalin), work for some of us. It also explains the nature of our pain and the way it moves around.

It also raises a new question - what is damaging our small fibers? Is it our immune systems, which would mean fibromyalgia is autoimmune? Do we lack an enzyme that aides in axon growth and repair? Is it a problem with cellular metabolism (mitochondrial dysfunction)?

Let's hope that researchers start asking those questions and looking for answers, because if it truly is nerve damage - and not just dysfunction - it brings us better credibility along with more concrete targets for treatment.

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Comments
March 27, 2013 at 1:00 pm
(1) Staci says:

Thank you for keeping us up to date. Every time I hear of a new study that confirms the reality of our disease I want to cheer!

I am hopeful that at minimum I will be validated by science in a definitave way in my life, if not cured.

OK, I have given up hope of seeing a cure, but validation I will take!

March 27, 2013 at 10:09 pm
(2) Abot Bensussen says:

I’ve had neuropathic pains in my feet over the last few years. So painful, electric shocks and walking on glass, some days I cry out it is such a sudden and sharp pain.

Lyrica, which has caused me 30 extra pains, is very helpful with these kinds of pain. My feet are doing much better. Really, how much can you do with sore feet?

I am so glad that research is continuing and that you, dear friend, report it to us. It gives me hope that understanding of our illness is not too far off. Thank, Abby

March 28, 2013 at 8:15 am
(3) DFWMom says:

Thank you for sharing this interesting development. It is my hope that the medical community can come to an understanding of the underlying mechanisms of this disease, because that is necessary in order to develop effective treatments. It is my hope that my thirteen year old daughter, who has primary juvenile fibromyalgia and suffers a great deal of pain and impaired function from this disease, to the point that she had to start home schooling, might be offered a truly effective treatment within a few years, while she is still young enough to enjoy her life.

March 28, 2013 at 10:58 am
(4) pratik shah says:

Hi Staci –

I’ve been following your articles for sometime now. I’m a male, age 33 and I’ve had fibromyalgia for a over a decade now, with a year of crippling, bed ridden pain in 2009 and 2010. No one understands, but I’m truly happy to see that you keep me and others in our position apprised of the latest on this terrible condition. With the help of the correct medication, I’ve improved some but still live with the struggles of pain and fatigue. I look forward to your posts, thanks for your hard work.

March 29, 2013 at 2:43 pm
(5) FibroFran says:

I just posted a comment on the wrong blog so here goes again. Yesterday I bought a “homeopathic” remedy for Neuralgia after trying Every drug out there for fibro. Well, it worked like magic and supports the finding in this study discussed. I run the whole gamut of fibro symptoms really bad and I think that this stuudy is really onto something big. I recommend fibromites try a homeopathic remedy, they are cheap and harmless and over the counter, and online, check it out and God Bless, fibrofran

March 29, 2013 at 4:47 pm
(6) JennyG says:

This is the answer to my most distressing symptoms!

I’ve seen every kind of doctor, only to have all of them look at me blankly when I try to describe the pain in the feel and hands. It’s almost always there, and if my stress level gets the slightest bit high (and usually by the end of every work day) I feel like my whole body is “screaming” with pain. It’s definitely nerve pain and I’ve always known it’s nerve pain, but no doctor will agree with me because I’m not diabetic and am only 42.

I already take neurontin, a good med for never pain, but that’s ok. This information gives me some serious new hope. If only just hope for validation.

Thank you, Adrienne. You’ve given me a starting point. Glad to read you’re feeling a little better. :-)

March 29, 2013 at 4:58 pm
(7) gina says:

interesting! i’m going into hospital today for a ketimine infusion. the theory behind it is that it regenerated the area in the brain which is ‘damaged’ and ‘resets’ the pain area so that it functions correctly. hope it works.
gina

March 29, 2013 at 6:20 pm
(8) kathy runnals says:

hello adrienne, i too thank you for all your hard work to keep us all informed. i look forward to hearing from you. i feel so validated after reading all you have prepared for us.

this is interesting information. this past year, my feet have started burning. the pain has increased until it is like fire and is about the worst pain i have. also my feet feel like they have turned to wood. oh, i guess i should say i’m 61, was dx with fibro in 1995. ok, so my dr said let’s check your circulation. that checks out fine. next we check for diabetes. that shows i have an increased risk, but that’s all. so now i am going to a neurologist for eval. and treat. diag.=peripheral neruopathy.
hmmmm, yes this is interesting. i’ll be standing by with baited breath for the latest findings. thanks again, adrienne, as we used to say back in the day, you ‘da bomb’.

March 29, 2013 at 6:30 pm
(9) Lizzy says:

My fibromyalgia started with a sprained ankle, not a “bad” one either, but that was 20 years ago. After a nerve conduction test I learned I have a very damaged nerve in that lower leg….burning pain every day since injury….but pain of course also took over my entire body in time. Gabapentin works well now to relieve my damaged nerve pain, but not any of the whole body pain. Yet all pain is the burning type, sometimes nagging muscle pain also. Savella works like a miracle not only for me but also for my daughter who has had fibro and CFS for longer than I have suffered and also has POTS. Can’t figure why Savella works well only on my body nerve pain and Gabapentin works only on my leg ‘s damaged nerve pain. Perplexing!! but thankful for relief. This is great news you bring for research attention to this new damaged nerves concept.

March 29, 2013 at 7:55 pm
(10) Denise says:

Hi Everyone,

I was told I have Fibro in 2009. I then started to have foot pain along with the electric shock pain. I take 3200 mg of Gabapentin a day and hydrocodone with Ibuprofen daily. I broke my ankle, more or less blew it
apart. I had to have surgery that night and have a plate with 8 screws. I was wondering if anyone had ever broken a bone with nueropathy. Did it cause the pain to become worse?

I am so glad I saw this article. It gives me a ray of hope that maybe some day we will all be out of pain.

March 29, 2013 at 8:13 pm
(11) Cindy H says:

Thank you very much Adrienne for keeping on top of fibro and cfs news in order to keep us informed – and to give us hope! With all that you have going on it can’t be easy to do all that you do. Glad things are a getting better. FibroFran, I hope you read this and would be kind enough to tell us exactly what homeopathic product you bought. I realize that each of us respond to treatment differently yet a “heads up” would be appreciated.

This news doesn’t surprise me though I’m glad the professionals are figuring some things out. I was put on gabapentin (neurotin) several years ago and it was working yet the severe downward mood swings were so bad I was taken off of it. Gabepentin is for neuropathy so there you go. It is a relief to see that doctors are seeing we aren’t a bunch of loonies.

March 29, 2013 at 9:51 pm
(12) Elle says:

Hi everyone,

I’ve experienced an increase in neuropathic pain over the past year, and was thinking about giving gabapentin (neurontin) a second try around. I use a duragesic patch for deep, incessant widespread pain and fascial pain, but it doesn’t help with my buzzing, burning, hyper-sensitive/ aroused/ vigilance skin issues.

The last time I tried gabapentin, I became extremely sleepy and my blood pressure dropped quite low. I did however experience a huge sense of relief with nerve pain. I’ve heard that the sleepiness passes eventually, and I’m wondering what your experience has been with this medication. How much does it help you, and how long did it take you to stabilize?

I had an allergic reaction to pregalabin (neurontic’s cousin), so that one’s been striken from the list. I’m not sure if there are any others that are specific to treatment of nerve pain, that are generally used for fibro… ?

March 29, 2013 at 10:25 pm
(13) Linda says:

Please FibroFran share with us the exact homeopathic medicine she used. I’m sure all of us would like to know.

Thanks a lot.

March 29, 2013 at 10:51 pm
(14) Pain Princess says:

Boy, I can relate to neurpathic pain. I get unpredictable waves of burning pain down my arms and legs, sometimes across my back. It is especially distressing because it frequently wakes me up or keeps me from getting to sleep. My neuro started me on Horizant, a form of gabapentin and that has helped, at least I am getting a little more sleep.

Thanks for the info!

March 30, 2013 at 6:48 am
(15) Celeste Cooper says:

Myofascial Pain Syndrome, characterized by chronic pain from myofascial trigger points, which are knotted up pieces of muscle fiber, is more common in fibromyalgia than once thought. There are studies that show it may be myofascial trigger points instead of tender points that are our arch nemesis. They are known as neurological imitators. My main issue with this particular study is that myofascial pain syndrome was not ruled out and myofascial trigger points could account for the irregularities that are reported. There is dysfunction at the neuro-muscular synapse in MPS. The reason this is important is that myofascial trigger points explain many neuropathies often seen in FM and other disorders too, such as interstitial cystitis, low back pain, costochondritis, tendonitis, bursitis,etc. There is treatment for myofascial pain syndrome and they are very successfully when done by therapists and physicians trained in the work of Travell and Simons. Great analogy and lesson on nerve fibers Adrienne. In healing and hope, Celeste, RN

March 30, 2013 at 9:56 am
(16) mary low says:

OMG this is so helpful. I have Fibro, that I know was caused from my work related injury! this is what I and my doctor felt for a long time……. now this confirms it in my head….ty so much for sharing this! gentle hugs to all <3 Mary

March 30, 2013 at 12:09 pm
(17) Pamela in Calgary, AB says:

If part of the damage is because there are nerves that are unmyelinated, does this relate then to MS, which is when the myelin sheath is damaged. It would be interesting to see if there’s a correlation.

March 30, 2013 at 1:23 pm
(18) Shelley in Victoria says:

This information is so great! Thank you! Interesting now with Pamela’s comment about MS. I have FM and have had it for at least 20 years. About 2 years ago I was having an MRI done on my ear for a hearing problem. The ear is fine, but they noticed that I had patches on my brain that were indicative of MS! I did see a neurologist, she felt that it was not MS but I could follow up and have another MRI in the future to see if there were any changes.

I’ll be checking back on this conversation and following along any new discoveries!

March 30, 2013 at 5:31 pm
(19) Christi 100 says:

Pamela’s comment is interesting as I was thinking the same thing. Fibro does have a lot of things in common with MS. Yes, Fran, what is this homeopathic remedy? Also I am going to try Savella as I find it is listed in my drug plan’s formulary. My husband has burning pain in the bottom of his feet. We both take gabapentin but maybe we need to increase the dosage. BTW, the sleepiness with gabapentin does go away. Was taking metformin (generic of Skelaxin) and my new insurance drug coverage won’t cover it now. Don’t know what I’m going to do as I get low back spasms without it. Good luck to you all and hope you can find some meds that work for you.
Chris

March 30, 2013 at 9:02 pm
(20) Nitalynn says:

I developed fibromyalgia after being hospitalized for emergency gall bladder surgery. They had to wait 48 hours to administer a rather large dose of antibotics because I have MVP (they have discontinued this practice I think.) I have always wondered if this high dose of antibotics could have been an event in some way responsible for my development of fibromyalgia. I know a lot of people do develop fibro after an illness or accident and wonder if we are all overlooking something very important. In researching peripheral neuropathy I came up with this. “Toxins can also cause peripheral nerve damage. People who are exposed to heavy metals (arsenic, lead, mercury, thallium), industrial drugs, or environmental toxins frequently develop neuropathy. Certain anticancer drugs, anticonvulsants, antiviral agents, and ANTIBOTICS (capitals mine for emphasis) have side effects that can include peripheral nerve damage, thus limiting their long-term use.” Here is the source. http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm#183593208
Has anyone else had an episode of large dose or doses of antibotics just prior to developing fibro?

March 30, 2013 at 11:39 pm
(21) Shelley says:

Nitalynn, your comment about antibiotics is interesting. When I was in my early 20′s (I’m 56 now) there was a whole year that I was on antibiotics as I had recurrent bladder infections every month. This is when I developed FM symptoms I believe. I also had two jaw surgeries, one at 18 and one at 24, and I know FM can be triggered in many different ways. Very hard to pinpoint I guess, but I’m happy to learn that the researchers are learning more.

March 31, 2013 at 5:42 am
(22) fibrofriend says:

i have been diagnosed with fms by 3 doctors along with the pain mainly in the thoracic back i now have burning and tingling i my feet and toes .i regularly wake with terrible pain in my back iv been taking lirical for 2 weeks i think it easing some of my pain im interested to know if any other fms sufferers experience the burning feet sensation and if so what do they do to ease it .hoping someone out there has some suggestions .

April 5, 2013 at 4:54 pm
(23) eaglehaslanded says:

A 2-fold here! First…. One of my many doctors had me on a daily dose of pure penicillin due to a mitral valve prolapse. Back then, if ANYTHING was goofy with your heart…..you were given large maintinance (sp?) doses. This lasted from 1971 to 1987 when it darned near destroyed my whole elimentary tract! Wondering,now, if this “helped” me to develop the Fibro. & CFS I’ve had for a good 20 yrs. ??!

2nd……I have such horrible neurapathic pain that there are times I just scream out in shocking pain because it IS so sudden …..I even have it in my torso…especially along my sternum & lower back. It’s like someone’s poking me with a red-hot poker!!! My feet are a mess,too. Where they don’t hurt….they’re numb as anything. To top it off, I have nightly bouts of restless legs. :(

Actually….I have begun to find similarities in Fibromyalgia & M.S.,also. I have a friend who started out with Fibro. & then it morphed into multiple sclerosis. Very scary!!!

And, yes…..Thank you so,so much dear Adrienne, for all the help you give us. You are our soul-provider, so to speak. God bless you.
Gentle (((hugs))) from eaglehaslanded

April 5, 2013 at 4:55 pm
(24) FibroFran says:

FIBROFRAN here: the name of the homeopathic company is HEEL and the product is “BACK” you can google it online. The bottle says for lower back pain, leg and hip pain and NEURALGIA. . Strangely it worked great instantly on my worst pain in my neck and shoulders, nothing else but for me thats incredible so I can sleep. ALSO, I took the prescribed 300 mg of gabapentin 3X a day too and went out of my mind, horrific tremors etc etc, worst week of my life BUT THEN I just took 300 mg at night right before bed and it stops the RLS and hands and feet maddness. Sometimes less is much better, I recommend trying it that way, really helps put me in a deep long sleep and I waker up so much better. I find it very strange that different meds help different areas of pain in the body. Ibuprofen helps my lower back and nothing else. We are some weird folks but we know what we mean lol My motto is that I Have a body I am NOT a body. take care all

April 5, 2013 at 5:59 pm
(25) sarah says:

no longer have cfs or fibro except skin sensitivity–clothes can bother me and if get hurt pain stays longer than usual–hense fibro nerve problem.

April 25, 2013 at 11:53 pm
(26) Antonio Marks says:

Thank you for taking time to share this one. It’s really helpful and very interesting. I’m looking forward to read more of your works.

May 13, 2013 at 8:41 pm
(27) Larryk says:

I was just told I have small fiber fibromyalgia in my low body (around waist line down.) What I’m curious about is something I noticed today. I’m sensitive to cold temps (around 65 deg F and below.) Today, was cold out and my legs ached all day today. I just took a warm shower, partially to try and sooth the pain temporarily. I can’t just up the heat in the house, I am developing an overall intolerance to heat.

Anyway, sorry got off track a bit, I noticed slight discoloration around the hair follicles on my legs. They are also raised around just the hairs. No other area on my body has that, which I can see. I tried even looking through a magnifying glass on both my legs and both my arms. The legs are different from the arms still. Both legs have the same issue at all of the hairs and, the arms have nothing at all. No raised bumps, no discoloration.

Is it something I can expect as things progress? Do all people with small fiber or just plain (not sure if there is a difference, I’m new to it sorry) fibromyalgia? I don’t seem to see the same if I look at the same areas on others (I used my family as test subjects.)

June 11, 2013 at 10:48 pm
(28) Virginia says:

Please everyone that have taken the Fluoroquinolone Antibiotics, Levaquin, Cipro, Avelox, and have any muscle, tissue, bone pain, burning painful skin, please research Fluoroquinolone Toxicity, it is nerve damage on the cellular level, millions have been damaged, victims are often misdiagnosed as Fibro, CFS, even MS, and Myofascial Pain Syndrome, there are several sites on facebook with thousands of victims, example, Fluoroquinolone Toxicity Group, The Wall of Pain, Surviving Cipro, Levaquin Toxicity Group, help and support

June 13, 2013 at 2:31 pm
(29) Stephanie says:

Everyone, please check your medicine cabinets for fluoroquinolones you may have taken in the past. In my case it was cipro pills and ear drops and high dose levaquin by IV and pill for extended period. This is nerve damage that neurologists need to acknowledge.

September 12, 2013 at 12:25 am
(30) Kelly says:

I highly recommend that all of you get tested for Lyme Disease. Most people are misdiagnosed for YEARS as having fibromyalgia, MS, CF, etc. The unfortunate thing is that many times a Lyme test will show a false negative and for some reason I have found that most doctors are unaware of this which leads to the misdiagnosis of something else – usually fibromyalgia.

Lyme causes all the symptoms most of you are describing!!

October 11, 2013 at 9:10 pm
(31) TerryTerry says:

I bet if everyone checked their records…the probably took a antibiotic from the Fluroquinolone Family. Cipro, Avelox ,Levaquin, Tequin Norafloxicin, Floxin just to name a few..and they come in ear and eye drops. These so called antibiotics cause nerve damage…Google ….:FDA August 15 2013 Fluroquinolones…..and you will see it for your self….Nerve Damage ! Not to mention all the tendon damage

November 24, 2013 at 9:54 pm
(32) Lois Bowyer says:

I have read all of the comments on here to see if I could find anyone that could answer the question. Would wearing the tight stretch socks help with the neuropathy .I’m not diabetic but was tested and I do have it. It seems that it only bothers me at night. The burning is awful and the Dr. has me on pain medication. I have tried Lyrica and Neurotin and the side effects were awful. If anyone has worn the tight socks to sleep in would you please let me know. . Thanks so much!

December 13, 2013 at 4:31 pm
(33) Fran says:

hi I went to to Neurologists and they both said it was a pain issue not a neurological issue.. Well where would I go for help
Fran
On. Canada

December 23, 2013 at 7:16 am
(34) Janet says:

I took a lot of cipro then 4 scripts of levaquin that blew my entire body apart. I have severe neuropathy pin and needles over my entire body. A lot of other issues about 40 of them but it DEFINATELY came from this drug. chills, pain, hornet stings all over, jaw, numb hands it is a nightmare.. Two black box warnings were released, the last aug 15 2013 that it can cause permanent neuropathy. PLEASE check as it will not show up on any blood work and thousands are being affected. The drug companies KNOW this and will not come forward.. Please see facebook wall of pain, So many of us are destroyed..rykerjem860@hotai.com

December 23, 2013 at 7:18 am
(35) Janet says:

I took a lot of cipro then 4 scripts of levaquin that blew my entire body apart. I have severe neuropathy pin and needles over my entire body. A lot of other issues about 40 of them but it DEFINATELY came from this drug. chills, pain, hornet stings all over, jaw, numb hands it is a nightmare.. Two black box warnings were released, the last aug 15 2013 that it can cause permanent neuropathy. PLEASE check as it will not show up on any blood work and thousands are being affected. The drug companies KNOW this and will not come forward.. Please see facebook wall of pain, So many of us are destroyed.It hit every part of my body snf, autonomic the works. pain is torture..rykerjem860@hotmail.com

January 8, 2014 at 12:14 am
(36) Victoria says:

Excellent article, thank-you for the information!!

January 23, 2014 at 10:09 pm
(37) Janet P. says:

This is some of the best and easiest to understand information on this subject that I’ve seen. I’m going to be tested for small fiber neuropathy soon. Thanks for the info.

March 13, 2014 at 4:40 pm
(38) charlotte says:

I have CFS and have intense torturous vaginal itching that is not the result of infection. It accompanied interstitial cystitis that I had forty yrs ago. They both went into remission. However, three years ago the itching came back. I saw Dr. Oaklander, who did the skin biopsy for SFPN and I definitely have it. I am being seen by her colleague to treat the neuropathic itching. We are using meds and Botox. Botox is to help control the spasms.

I had severe FMS the first year I had CFS; the FM went into remission but I still have the tender points. I actually had them years before when I saw a rheumatologist who dx Sjogren’s syndrome.

Celeste, I had a dedicated, gifted p.t. who did the Travell, Simons work on me. It simply didn’t help.

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