Fibromyalgia is a syndrome that causes diffuse pain throughout the body. Unfortunately, many practitioners still believe it is strictly a psychological disorder and many of the patients are faking symptoms. New research has now been finding objective changes that correlate to the symptoms in fibromyalgia. These findings however are not leading to tests to prove whether a person does or does not have the syndrome.
Diffuse whole body pain with muscle tenderness, abdominal complaints, headaches, fatigue, and sleep issues all are prominent characteristics of fibromyalgia. Currently, the diagnosis is made by history and exam of a patient, then by excluding other diseases such as diabetes, thyroid dysfunction and rheumatoid arthritis. The disease is much more common in females and first becomes symptomatic in the mid- to late-twenties but sometimes as late as the fifties to early sixties. The severity can be highly variable, from mild to disabling. Treatment is basically symptomatic at this time.
New Fibromyalgia Research
Dr. Anne Louise Oaklander of Massachusetts General Hospital studied 27 patients with fibromyalgia as diagnosed with the American College of Rheumatology criteria of the disease, and used a group of 30 matched control subjects. Skin biopsies were taken of the lower leg and 41% of the patients met the criteria of small fiber polyneuropathy. Her team also studied a group of 41 patients who had fibromyalgia begining as a juvenile, and 59% of those had small fiber polyneuropathy as diagnosed with a skin biopsy. Further study of these same patients indicate some of them appeared to have an immune component, like those with rheumatoid or lupus arthritis, and when treated similarly they improved in symptoms. Small fiber polyneuropathy is also seen in diabetes and vascular disease and is associated with the pain these patients experience. Unfortunately, the definitive test for this type of neuropathy is a biopsy (which is a removal of a small patch of skin) and microscopically examining it for nerve fiber endings, which is quite complex.
The importance of this study is that these findings indicate that there is real pathology behind fibromyalgia. It is not psychosomatic or imaginary. It also makes the disease more understandable. The small nerve fibers are those that carry pain sensations. If these fibers are abnormal, the result is pain. These fibers exist throughout the body, in the limbs one would have muscle pain, in the head one would get headaches, and in the trunk one might have stomach problems.
Small fiber neuropathy and peripheral neuropathy are currently best treated with medications that affect nerve cell function. The common medications, know as neuropathics, including gabapentin, Lyrica, Cymbalta, some other antidepressants, and a few miscellaneous medications are helpful. Opioids are very poor medications for this and help very little if at all. Fibromyalgia seems to respond in a similar way, and if it is a small fiber neuropathy, the same treatments would be beneficial.
Improving the understanding of the cause of fibromyalgia and the changes that exist in the body hopefully will lead to better treatment. Not all patients with fibromyalgia have these findings of small fiber neuropathy on biopsy. This syndrome may have different causes, and the treatment may vary due to these differences. Knowing that about half of the patients at least probably have small fiber neuropathy allows physicians to focus treatments that are effective for these problems. Further, the youngest patients with fibromyalgia commonly have immune system dysfunction and treatment for these disorders has also been showing promise. Fibromyalgia is slowly moving from a “psychological” problem to an objective medical syndrome with definitive findings.
Thomas Cohn, MD
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