Fibromyalgia: Research has Discovered Nerve Pathology

Today we will be discussing two things every fibromyalgia patient and doctor treating fibromyalgia patients should be aware of.  They are small fiber peripheral neuropathy and nocioceptor dysfunction.  In today’s broadcast we will not only explain what these issues are, but also discuss the current scientific literature demonstrating these peripheral nerve and receptor issues to be present in a significant percentage of fibromyalgia sufferers.  We will also illustrate what this research means to you as the fibro patient and how novel therapies in the future addressing small fiber neuropathy and nocioceptors may improve fibromyalgia patient outcomes.


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1.The Role and Importance of Small Fiber Neuropathy in Fibromyalgia Pain.
Caro XJ, Winter EF.
Curr Pain Headache Rep. 2015 Dec;19(12):55. doi: 10.1007/s11916-015-0527-7.
PMID: 26497568 [PubMed – in process]
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2.Progress in the treatment of small fiber peripheral neuropathy.
Chiang MC, Tseng MT, Pan CL, Chao CC, Hsieh ST.
Expert Rev Neurother. 2015 Mar;15(3):305-13. doi: 10.1586/14737175.2015.1013097. Epub 2015 Feb 9. Review.
PMID: 25664678 [PubMed – indexed for MEDLINE]
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3.Oxidative stress, mitochondrial dysfunction and, inflammation common events in skin of patients with Fibromyalgia.
Sánchez-Domínguez B, Bullón P, Román-Malo L, Marín-Aguilar F, Alcocer-Gómez E, Carrión AM, Sánchez-Alcazar JA, Cordero MD.
Mitochondrion. 2015 Mar;21:69-75. doi: 10.1016/j.mito.2015.01.010. Epub 2015 Feb 7.
PMID: 25662535 [PubMed – indexed for MEDLINE]
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4.Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia.
Doppler K, Rittner HL, Deckart M, Sommer C.
Pain. 2015 Nov;156(11):2319-25. doi: 10.1097/j.pain.0000000000000285.
PMID: 26164586 [PubMed – indexed for MEDLINE]
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5.Small fiber neuropathy in women with fibromyalgia. An in vivo assessment using corneal confocal bio-microscopy.
Ramírez M, Martínez-Martínez LA, Hernández-Quintela E, Velazco-Casapía J, Vargas A, Martínez-Lavín M.
Semin Arthritis Rheum. 2015 Oct;45(2):214-9. doi: 10.1016/j.semarthrit.2015.03.003. Epub 2015 Mar 19.
PMID: 26094164 [PubMed – indexed for MEDLINE]
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6.The Local and Systemic Actions of Duloxetine in Allodynia and Hyperalgesia Using a Rat Skin Incision Pain Model.
Wang CF, Russell G, Strichartz GR, Wang GK.
Anesth Analg. 2015 Aug;121(2):532-44. doi: 10.1213/ANE.0000000000000794.
PMID: 26049779 [PubMed – indexed for MEDLINE]
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7.Hypothesis: Human papillomavirus vaccination syndrome–small fiber neuropathy and dysautonomia could be its underlying pathogenesis.
Martínez-Lavín M.
Clin Rheumatol. 2015 Jul;34(7):1165-9. doi: 10.1007/s10067-015-2969-z. Epub 2015 May 20. Review.
PMID: 25990003 [PubMed – indexed for MEDLINE]
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8.Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software.
Pilar Bambo M, Garcia-Martin E, Gutierrez-Ruiz F, Magallon R, Roca M, Garcia-Campayo J, Perez-Olivan S, Polo V, Larrosa JM, Pablo LE.
J Fr Ophtalmol. 2015 Sep;38(7):580-7. doi: 10.1016/j.jfo.2015.01.010. Epub 2015 May 11.
PMID: 25976129 [PubMed – indexed for MEDLINE]
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9.Routine use of punch biopsy to diagnose small fiber neuropathy in fibromyalgia patients.
Levine TD, Saperstein DS.
Clin Rheumatol. 2015 Mar;34(3):413-7. doi: 10.1007/s10067-014-2850-5. Epub 2014 Dec 24. Review.
PMID: 25535201 [PubMed – indexed for MEDLINE] Free PMC Article
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10.Microneurographic recording from unmyelinated nerve fibers in neurological disorders: an update.
Donadio V, Liguori R.
Clin Neurophysiol. 2015 Mar;126(3):437-45. doi: 10.1016/j.clinph.2014.10.009. Epub 2014 Oct 17. Review.
PMID: 25457652 [PubMed – indexed for MEDLINE]
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11.Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: a controlled study.
Kosmidis ML, Koutsogeorgopoulou L, Alexopoulos H, Mamali I, Vlachoyiannopoulos PG, Voulgarelis M, Moutsopoulos HM, Tzioufas AG, Dalakas MC.
J Neurol Sci. 2014 Dec 15;347(1-2):143-7. doi: 10.1016/j.jns.2014.09.035. Epub 2014 Sep 28.
PMID: 25304055 [PubMed – indexed for MEDLINE]
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12.Evidence of abnormal epidermal nerve fiber density in fibromyalgia: clinical and immunologic implications.
Caro XJ, Winter EF.
Arthritis Rheumatol. 2014 Jul;66(7):1945-54. doi: 10.1002/art.38662.
PMID: 24719395 [PubMed – indexed for MEDLINE] Free Article
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13.Non-length dependent small fiber neuropathy. a prospective case series.
Gemignani F, Giovanelli M, Vitetta F, Santilli D, Bellanova MF, Brindani F, Marbini A.
J Peripher Nerv Syst. 2010 Mar;15(1):57-62. doi: 10.1111/j.1529-8027.2010.00252.x.
PMID: 20433606 [PubMed – indexed for MEDLINE]
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14.Longitudinal Assessment of Small Fiber Neuropathy: Evidence of a Non-Length-Dependent Distal Axonopathy.
Khoshnoodi MA, Truelove S, Burakgazi A, Hoke A, Mammen AL, Polydefkis M.
JAMA Neurol. 2016 Jun 1;73(6):684-90. doi: 10.1001/jamaneurol.2016.0057.
PMID: 27065313 [PubMed – in process]
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15.[Fibromyalgia syndrome: A disease of the small nerve fibers?].
Üçeyler N, Sommer C.
Z Rheumatol. 2015 Aug;74(6):490-2, 494-5. doi: 10.1007/s00393-014-1546-1. Review. German.
PMID: 26169747 [PubMed – indexed for MEDLINE]
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