Fomyalgia
For Fibromyalgia Patients
Research from Massachusetts GeneralHospital suggests that somecases of fibromyalgia have a neurological cause.
Neurology faculty members Anne Louise Oaklander, MD, PhD and Max Klein PhD and their teamhave published two studies suggesting that at least half of patients with fibromyalgia – a common cause of widespread chronic pain and other symptoms –have evidence of a neurological disease called small-fiber polyneuropathy (SFPN). Theirpublications in prominent peer-reviewed journals [5][4]have beenwidely profiled including byABC News and USA Today. These findings, confirmedby other laboratories [1;6;7], are the first pathological abnormalities found in fibromyalgia patients. Until nowfibromyalgia has beena label based on symptoms alone,meaning no possibility of treating the underlying causes. The new findings linking fibromyalgia to SFPN may make that possible since SFPN is caused by underlying medical conditions that can sometimes be identified and treated effectively [2].
How can fibromyalgia patients get tested for SFPN?
The published studies used skin biopsies to identify those fibromyalgia patients who seemed to have SFPN. This involves removing one or more tiny skin samples of anesthetized skin from patients’ lower leg and counting the nerve endings within. Low numbers objectively demonstrate damage to the small-fiber nerve endings. This test is endorsed for SFPN diagnosis by the AmericanAcademy of Neurology [3].
There are two ways to get skin biopsy analysis at MGH. All patients not already registered at MGH must phone 1-866-211-6588 to register and provide insurance information.
1. For patients able to travel to MGH, their physician can refer them to have skin biopsy performed and analyzed at MGHby submitting this requisition form.
2. For distant patients unable to travel to MGH, their physician can perform the skin biopsies in their own offices and ship them to MGH for interpretation and a Pathology report. To arrange to ship skin biopsies to MGH for analysis, call Heather Downs at 617-726-0260.
What if skin biopsy suggests that you have small-fiber polyneuropathy (SFPN)?
Identifying the cause of SFPN can help doctors and patients choosebetter treatments, so we recommend that patients with skin biopsiesinterpreted as SFPN seek advice from nerve specialiststo look for its underlyingcauses. Potentially treatable causes of SFPN include diabetes, vitamin deficiencies, toxins, autoimmunity, and cancers. Targeted treatment may permit nerves to heal and symptoms to improve. Most large hospitals have neurologists who specialize in peripheral nerve disorders. For an appointment with MGH’s nerve specialists, phone 855-644-6387.
"Until now, there has been no good idea about what causes fibromyalgia, but now we have evidence for some but not allpatients. Fibromyalgia is too complex for a 'one size fits all' explanationso we are continuing our research" says Oaklander, an Associate Professor of Neurology atHarvardMedicalSchool. This research on fibromyalgia was possible because of the generosity of individual donors and foundations. For information about how to contribute to support this ongoing work, contact the MGH Development Office at 617-643-0447 or e-mail .
Reference List
View Dr. Oaklander's Publications on PubMed
[1] Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL. Excessive peptidergic sensory innervation of cutaneous arteriole-venule shunts (AVS) in the palmar glabrous skin of fibromyalgia patients: Implications for widespread deep tissue pain and fatigue. Pain Med 2013;14:895-915.
[2] Amato AA, Oaklander AL. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 16-2004. A 76-year-old woman with numbness and pain in the feet and legs. N Engl J Med 2004;350:2181-2189.
[3] England JD, Gronseth GS, Franklin G, Carter GT, Kinsella LJ, Cohen JA, Asbury AK, Szigeti K, Lupski JR, Latov N, Lewis RA, Low PA, Fisher MA, Herrmann DN, Howard JF, Jr., Lauria G, Miller RG, Polydefkis M, Sumner AJ. Practice Parameter: Evaluation of distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 2009;72:177-184.
[4] Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain 2013.
[5] Oaklander AL, Klein MM. Evidence of small-fiber polyneuropathy in unexplained, juvenile-onset, widespread pain syndromes. Pediatrics 2013;131:e1091-e1100.
[6] Solà R, Collado A, Antonelli F, Quiles C, Serra J. Is fibromyalgia a special type of small fiber neuropathy? A microneurography study. Meeting of the International Association for the Study of Pain 2012.
[7] Üçeyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, Casanova-Molla J, Reiners K, Sommer C. Small fibre pathology in patients with fibromyalgia syndrome. Brain 2013.