Researchers have found the main source of pain in Fibromyalgia patients, and contrary to what many believe, it does not stem from the brain. The findings mark the end of a decades-old mystery about the disease, which many doctors believed was conjured in patients’ imaginations. The mystery of Fibromyalgia has left millions of sufferers searching for hope in pain medications. Up until recently, many physicians thought that the disease was “imaginary” or psychological, but scientists have now revealed that the main source of pain stems from a most unlikely place- excess blood vessels in the hand.
The discovery may lead to new treatments and perhaps even a total cure in the future, bringing relief to as many as 5 million Americans thought to have the disease. To solve the Fibromyalgia mystery, researchers zeroed in on the skin from the hand of one patient who had a lack of the sensory nerve fibers, causing a reduced reaction to pain. They then took skin samples from the hands of Fibromyalgia patients and were surprised to find an extremely excessive amount of a particular type of nerve fiber called arteriole-venule (AV) shunts.
Up until this point scientists had thought that these fibers were only responsible for regulating blood flow, and did not play any role in pain sensation, but now they’ve discovered that there is a direct link between these nerves and the widespread body pain that Fibromyalgia sufferers feel.
The breakthrough also could solve the lingering question of why many sufferers have extremely painful hands as well as other “tender points” throughout the body, and why cold weather seems to aggravate the symptoms. In addition to feeling widespread deep tissue pain, many Fibromyalgia patients also suffer from debilitating fatigue.
Neuroscientist Dr. Frank L. Rice explained: “We previously thought that these nerve endings were only involved in regulating blood flow at a subconscious level, yet here we had evidences that the blood vessel endings could also contribute to our conscious sense of touch… and also pain,” Rice said. “This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation fibromyalgia patients. This, in turn, could contribute to the hyperactivity in the brain.”
Pain Med. 2013 Jun;14(6):895-915. doi: 10.1111/pme.12139. Epub 2013 May 20.
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.
Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL.
Integrated Tissue Dynamics, LLC, Rensselaer, New York, USA; Center for Neuropharmacology & Neuroscience, Albany Medical College, Albany, New York, USA.
To determine if peripheral neuropathology exists among the innervation of cutaneous arterioles and arteriole-venule shunts (AVS) in fibromyalgia (FM) patients.
Cutaneous arterioles and AVS receive a convergence of vasoconstrictive sympathetic innervation, and vasodilatory small-fiber sensory innervation. Given our previous findings of peripheral pathologies in chronic pain conditions, we hypothesized that this vascular location may be a potential site of pathology and/or serotonergic and norepinephrine reuptake inhibitors (SNRI) drug action.
Twenty-four female FM patients and nine female healthy control subjects were enrolled for study, with 14 additional female control subjects included from previous studies. AVS were identified in hypothenar skin biopsies from 18/24 FM patient and 14/23 control subjects.
Multimolecular immunocytochemistry to assess different types of cutaneous innervation in 3 mm skin biopsies from glabrous hypothenar and trapezius regions.
AVS had significantly increased innervation among FM patients. The excessive innervation consisted of a greater proportion of vasodilatory sensory fibers, compared with vasoconstrictive sympathetic fibers. In contrast, sensory and sympathetic innervation to arterioles remained normal. Importantly, the sensory fibers express α2C receptors, indicating that the sympathetic innervation exerts an inhibitory modulation of sensory activity.
The excessive sensory innervation to the glabrous skin AVS is a likely source of severe pain and tenderness in the hands of FM patients. Importantly, glabrous AVS regulate blood flow to the skin in humans for thermoregulation and to other tissues such as skeletal muscle during periods of increased metabolic demand. Therefore, blood flow dysregulation as a result of excessive innervation to AVS would likely contribute to the widespread deep pain and fatigue of FM. SNRI compounds may provide partial therapeutic benefit by enhancing the impact of sympathetically mediated inhibitory modulation of the excess sensory innervation.
Wiley Periodicals, Inc.
[PubMed - in process]
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