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Some cases of Fibromyalgia may actually be small-fiber polyneuropathy
Tuesday 25 June 2013
Editor's comment: Small-fiber polyneuropathy involves body-wide damage to the small unmyelinated nerve fibers. (Unmyelinated means the nerve fibers do not have a myelin sheath – the fatty substance that covers and protect nerves.)
Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia.
Fibromyalgia is a common, disabling, syndrome that includes chronic widespread pain plus other diverse symptoms. No specific objective abnormalities have been identified, precluding definitive testing, disease-modifying treatments, and identification of causes.
In contrast, small-fiber polyneuropathy (SFPN), despite causing similar symptoms, is definitionally a disease caused by dysfunction and degeneration of peripheral small-fiber neurons. SFPN has established etiologies, some diagnosable and definitively treatable, e.g., diabetes.
To evaluate the hypothesis that some patients labeled with "fibromyalgia" have unrecognized SFPN causing their illness symptoms, we analyzed SFPN-associated symptoms, signs, and pathological and physiological markers in 27 fibromyalgia patients and 30 matched normal controls. Fibromyalgia subjects had to satisfy American College of Rheumatology criteria plus document actual fibromyalgia diagnoses.
Study instruments comprised the Michigan Neuropathy Screening Instrument (MNSI), the Utah Early Neuropathy Scale (UENS), distal-leg neurodiagnostic skin biopsies, plus autonomic-function testing (AFT).
These findings suggest that some pain patients labeled with "fibromyalgia" have unrecognized small-fiber polyneuropathy, a distinct disease that can be objectively tested for and sometimes definitively treated.
Source: Pain, June 5, 2013. By Anne Louise Oaklander, Zeva Daniela Herzog, Heather Downs and Max M. Klein. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114; Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, Massachusetts, 02114.
The above originally appeared here.
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