Scientists have uncovered new insight into why fibromyalgia patients experience widespread pain and fatigue, and have confirmed that the condition isn’t imaginary.
An estimated 10 million people in the US suffer from fibromyalgia syndrome, but diagnosing and treating the condition is challenging since scientists still don’t understand the causes. Research has found that the fatigue and pain may be caused by hypersensitivity of nerve cells in the central nervous system (central sensitization), but no other studies have identified any other clear causes. As a result some doctors are skeptical about whether the condition actually exists, or whether it’s “all in the head.”
Now researchers from Albany Medical College and Integrated Tissue Dynamics (Intidyn) have discovered a biological basis for the fatigue and pain associated with fibromyalgia.
“Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” explained researcher and president of Intidyn, Dr. Frank Rice, in a press release. “This discovery provides concrete evidence of a fibromyalgia-specific pathology which can now be used for diagnosing the disease, and as a novel starting point for developing more effective therapeutics.”
In 2010, researchers discovered a new function of tiny nerve fibers within the blood vessels of the skin. Previously these nerve fibers were believed to be only involved in regulating blood flow, but the researches found they also contribute to our sense of touch and pain.
In this latest study, researchers found that fibromyalgia patients had an excess of these nerve fibers around certain sites in the skin, which may partially explain their increased sensitivity to pain.
Researchers took tiny skin biopsies from the hands of women with and without fibromyalgia and analyzed the samples for abnormalities. Compared to healthy controls, the women with fibromyalgia had increased sensory nerve fibers around certain sites within the blood vessels of the skin. These sites are muscle valves called arteriole-venule (AV) shunts which form a direct connection between tiny arteries and veins, and help to regulate blood flow and body temperature. In cold weather, the shunts open up, allowing the blood to bypass the capillaries to conserve heat. Since the sensory fibers activate the shunts, dysfunctions of the sensory fibers could explain why many fibromyalgia patients say their symptoms worsen in cold weather.
Causes of Widespread Pain
While these shunts are mostly found only in the hands and feet, they also have another crucial function that could explain widespread pain, achiness, and fatigue in patients in FMS patients.
Dr. Rice explains that a tremendous amount of blood flow goes to our hands and feet, far more than is actually needed. The hands and feet help to act as reservoir of blood flow that can be drawn upon when muscles and tissues in the body are under strain or exercised. Problems with the shunts in the hands could interfere with blood flow throughout the body.
“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,” Dr. Rice explained. “This, in turn, could contribute to the hyperactivity in the brain.”
The findings demonstrate that fibromyalgia isn’t “all in the head”, and open up new areas of potential research into more effective diagnosis and therapy. Earlier research has suggested that exercise, tai chi, and chiropractic can all help to ease symptoms in patients with fibromyalgia.
Albrecht PJ, et al. 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 Medicine 2013; 14(6):895-915. doi: 10.1111/pme.12139.
Fibromyalgia is not all in your head, new research confirms. Integrated Tissue Dynamics. Press release. June 14, 2013.
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