Recent Studies Show Link Between Fibromyalgia and Small-Fiber Polyneuropathy
Fibromyalgia (FM) is a musculoskeletal syndrome that starts in the brain and causes widespread pain in the joints and muscles coupled with intense fatigue, sleep, mood and memory issues. More than twelve million people suffer from FM syndrome with most of the affected being women between the ages of twenty-five and sixty. The fatigue that FM patients feel is one that often leaves them unable to get out of bed or stand well. Some of the effects of having FM culminate in anxiety, depression, tension headaches, IBS and TMJ.
The pain responses in people with FM are overly sensitive and they react more strongly to pain stimuli. Because all of the symptoms that FM patients experience are also symptomatic of other diseases and disorders, and because the symptoms are not always consistent, it can be difficult to obtain a diagnosis and the road from symptoms to diagnosis can be a long, painful and isolating one. There is no test for FM, making the disorder hard to confirm. They can’t just take blood or do an x-ray to confirm symptoms. In order for diagnosis to occur, doctors must rely on the grouping of a patient's symptoms.
It’s been recently found though that almost half of patients in a study done at Massachusetts General have what is known as Small Fiber Polyneuropathy (SFPN), prompting physicians to call for testing of this disorder in patients labeled as FM patients. The prompt is owed to SFPN having a set criterion that can be established when diagnosing, it’s thought that if used, more patients with FM may be easier to Identify.
Fibromyalgia starts in the brain and it is a musculoskeletal syndrome. In the joints and muscles it causes widespread pain along with intense fatigue, mood, memory and sleep issues. It has been found that in almost half of the FM patients they have small fibre poly neuropathy. This has prompted the physicians to test for this disorder too.
In FM, the pain is amplified. Thus even to slightest pain stimuli the person becomes overly sensitive. It is believed that in such people the signals are processed by the pain centres of the brain and spinal cord differently. Usually after an infection or after a traumatic physical encounter or during the time of intense psychological stress, the symptoms begin. In some cases, over time the symptoms accumulate. The symptoms of FM are mimicked by other disorder thus diagnosis is difficult. Certain guidelines and specific physical tests have been set by the American College of Rheumatology. A persistent widespread pain for at least three months, not having any other disorders or disease that can cause trouble thinking or feeling tired after waking up are the baseline for testing.
In small fibre polyneuropathy, the small nerves are damaged. These nerves to the body supply tactile sensation, help in breathing, regulate heart rate, help in digestion and control perspiration. It is believed that an immune response causes this. Small fibre polyneuropathy occurs in the peripheral nervous system. Numbness, tingling in the affected area or burning are the usual symptoms. However, in an upward trajectory, these symptoms may travel. Usually in the adolescence to mid adulthood, the symptomsmay start. The pain is centralized in the whole body initially later as the patient ages, into the extremities the pain will extend. A genetic component involvement has been found in majority cases. The usual diagnosis is taking a family and medical history, lab tests and physical examination. Electromyography and nerve conduction studies are done to eliminate the involvement of motor and large nerve fibres. To verify loss of cutaneous nerve innervation, skin biopsies are done. Experimental protocols are being used by researchers for treatment of FM along with the normal FDA approved medicines. This approach has been successful to treat small fibre polyneuropathy in patients with both the disorders.
Growth hormones- improved pain tolerance and fatigue reduction was experienced by used patients, but for many the issue was unexpected side effects and the high cost.
Cannabis- in many cases, the active ingredient found in cannabis that is synthetic THC was found to be of immense help. It helped in sleep issues and also aided pain. Some side effects were present but it was found that these side effects were not life threatening.
Quenpentadine- the dopamine and serotonin levels are enhanced by using it for short term. It is an anti-psychotic and the sympathetic nervous system responses to brain are blocked by it. Increased fatigue is a side effect and already in FM patients this is a symptom that is already present. However, for long term solution for many this is a less than ideal solution.