Dec 9, 2014
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Here's a link to my Facebook page if you want to "LIKE" it.
I also have a group here called Anti Inflammatory Eating. Fibro is an auto immune disease which is caused by inflammation. Eating an anti inflammatory diet and taking the proper all natural supplements is the key to controlling fibromyalgia.
Small fiber neuropathy, rather than central sensitization, may be responsible for the pain associated with fibromyalgia, some researchers have hypothesized.
Skin biopsies revealed lower mean epidermal nerve fiber density among patients with fibromyalgia compared with controls at both the calf, according to X. J. Caro, MD, of Northridge Hospital Med Cntr in Northridge, Calif., and E. F. Winter, PhD, of North Central University in Ariz.
This "surprisingly high prevalence" of decreased epidermal nerve fiber density suggested peripheral nervous system injury that could be contributing to pain, according to the authors.
There also was an inverse correlation between the epidermal nerve fiber density at the calf and interleukin , which is an activation marker of T-cells and macrophages, supporting the additional concept that this is an immune-mediated process, Caro and Winter reported online in Arthritis & Rheumatology.
"These observations indicate that the current operative paradigm in fibromyalgia, in which central sensitization is viewed as the prime mover in this disorder, requires modification," they wrote.
Neuropathy and Fibromyalgia?
Other experts urge caution, however.Daniel J. Clauw, MD, of the University of Michigan in Ann Arbor, who has conducted extensive research into fibromyalgia and recently wrote a clinical review of the condition in JAMA, said, "We simply don't know yet what finding small fiber neuropathy means in fibromyalgia."
"Small fiber neuropathy has been found in multiple chronic pain conditions so the meaning of this finding is unclear. Also, many cardinal symptoms of fibromyalgia (fatigue, sleep, memory, and mood disturbances) cannot be explained by neuropathy, and the distribution of the pain in fibromyalgia (e.g., headaches, irritable bowel, interstitial cystitis) doesn't match that of small fiber neuropathy. So we need to be careful about drawing conclusions from these findings," Clauw told MedPage Today.
The underlying pathophysiology associated with fibromyalgia continues to be uncertain, at least in part because of the lack of a specific tissue lesion.
"As a result, the idea has developed that a central nervous system origin for fibromyalgia is the only viable explanation for its existence," Caro and Winter wrote.
They noted that their interest into a potential peripheral nervous system origin for fibromyalgia stemmed from their observation that many patients described their pain in terms similar to those used by patients with peripheral neuropathy.
They previously explored this by electrodiagnostic testing and sural nerve biopsies, but such biopsies are difficult and expensive. More recently, reports have suggested that skin biopsies to quantitate epidermal nerve fiber density could be a useful tool for the evaluation of peripheral neuropathy. Part 2 cont.
Take these pages to your doctor is it is hard to understand, as it is from a more professional journal. But I wanted to get out the information as your Dr. may be able to help further in your case if he knows! :)
An editorial accompanying the study described the understanding of fibromyalgia as still incomplete.
"What we call fibromyalgia may be at the crossroads of different pathophysiological situations with a common clinical background phenotype," wrote Piercarlo Sarzi-Puttini, MD, and Fabiola Atzeni, MD, PhD, of Sacco University Hospital in Milan.
"Where does fibromyalgia originate? Is it due to a genetic and/or familial predisposition, a stress-related personality disorder, a psychoaffective disorder, or a post-traumatic stress disorder? It may be all of these or none," Sarzi-Puttini and Atzeni commented.
"All we can do is continue to look for tissue abnormalities and central processing alterations in an attempt to discover which come first, and then develop the best therapeutic (or, even better, preventive) strategy for the 2% to 3% of the population who suffer from the disease," the editorialists concluded.
end of article.
Between January 2007 and August 2011 Caro and Winter assessed 41 consecutive patients who met the 1990 American College of Rheumatology criteria for fibromyalgia, along with 47 controls.
Participants underwent sensory testing, laboratory analyses, physical examinations, and punch skin biopsies at the anterolateral proximal thigh and distal leg.
The majority were women. Mean ages were 61 years for patients and 48 for controls.
All patients showed a "stocking distribution" of diminished sensory perception.
Among other findings were:
A significant inverse correlation between age and calf epidermal nerve fiber density in patients (r=-0.29, P=0.03), though not controls
A trend toward a significant inverse correlation between epidermal nerve fiber density at the thigh and IL-2R in the fibromyalgia patients (r=-0.22, P=0.08)
A trend was toward significance between symptom duration and IL-2R (r=-0.24, P=0.07), though not with epidermal nerve fiber density at either calf or thigh
"As a signal, IL-2R has been thought reliable enough so that it has been used to monitor the course of some autoimmune diseases," Caro and Winter wrote.
In addition, patients' pain rating on a 10-point scale and physician global 3-point tenderness score correlated with each other (r=0.51, P=0.0005) although pain didn't correlate with nerve fiber density.
Pain and Immunity
Small fiber neuropathy is associated with both loss of sensation to the skin and peripheral pain, so the finding of the stocking distribution of diminished perception was "not unexpected," according to the authors.
"The painful peripheral symptoms of small fiber neuropathy, on the other hand, are thought to be due to a disproportionate hyperexcitability of the primary, lesioned -- but not altogether defunct -- small nerve fibers and a surrounding, structurally normal, but physiologically hyperexcitable group of secondary small nerve fibers responding collaterally," they wrote.
But small fiber neuropathy isn't an entirely new concept, according to Ali Askari, MD, of UH Case Medical Center in Cleveland.
"It has come to light in the last decade, and explains a lot of the uncomfortable feelings in the legs and hands and other parts of the body in fibromyalgia," Askari said in an interview.
The exact reason for decreased epidermal nerve fiber density in these fibromyalgia patients "is not entirely self-evident," Caro and Winter noted.
"Nevertheless, in the absence of data implicating any other known neuropathic disorder in the genesis of this lesion, we consider it likely that an immunopathogenic mechanism is at work in this patient population," they wrote.
"According to our data, this nexus between the immune system and fibromyalgia is likely to be influenced by a T-cell mediated arm. It may also involve factors within a system commonly referred to as neurogenic inflammation," they added.
Another View..continued in part three.
take all three pages to your doctor.
This is not in order, as you see, down the page, but all the information is here, even the original source.
I would suggest you take it to your doctor.
I tried to inactivate the hyperlinks in part one only, and I hope anyone wanting to search more will go to the listed article.
I have been working on this for an hour and a half, so forgive the imperfections, and the lack of direct links. But this is an important connection that the medical community has made. It may be of use to your doctor, even to begin looking at intervention in a new way to assist you with your pain, your other symptoms, and help you in a more efficient way. At the very least, to explore new options himself, for his education into Fibro and how it may help him to research some of the new materials available!
I wish you peace, pain free, or reduced pain for better, happier, living, and a doctor who respects you, your story, and will work with you.
Feb 11, 2014