New Findings in Fibromyalgia: What Do They Mean?

In a recent USA Today article, New Findings in Fibromyalgia, many articles from different medical journals are cited. I did some medical sleuthing by reading the original articles and by taking the extra step of speaking to the researchers who are quoted.

These Are the Key Points:

• Fibromyalgia is a complicated disease without question. Most doctors are quick to run in the other direction when asked to see a patient with fibromyalgia.
• It is very important that a thorough evaluation is done to make sure that a neurologic disease (like multiple sclerosis) or an endocrine disease (e.g. diabetes) is not the underlying cause for the pain. Those conditions can either be easily diagnosed by radiographic or blood tests, but sometimes (at early stages) can be missed.

At Mitchell Medical Group, when I am evaluating a patient who may have fibromyalgia I order in-depth laboratory tests to make sure there is no underlying metabolic, endocrine or autoimmune condition that would support another diagnosis.

The New Findings Reported by Researchers Are the Following:

Dr. Anne Louise Oaklander, MD PhD

Dr. Anne Louise Oaklander, a neurology researcher at Massachusetts General Hospital, reports that 50% of her female patients with Fibromyalgia, actually have another condition called Small Fiber Polyneuropathy. Small Fiber Polyneuropathy is an esoteric diagnosis that is found in multiple other conditions. The diagnosis is made by a skin biopsy of the palm of the hand. The pathology shows increased nerve fibers in the region biopsied. The extra nerve fibers help to explain the patient’s extra sensitivity to pain because of the “extra wiring” of the nervous system.

The article shows a picture of Carolyn DiSilva, a patient of Dr. Oaklander, receiving intravenous gamma globulin to relieve her pain. Ms. DiSilva stated that her pain decreased from a 10 to a 4 (out of 10) on this treatment. At Mitchell Medical Group, we use injections of gamma globulin instead of IV gamma globulin with good results.

Frank L. Rice, PhD

Another new finding was reported by Charles Argoff, M.D. at Albany Medical Center and Frank Rice, Ph.D. at Integrated Tissue Dynamics this summer. This research team showed that the pathology in Fibromyalgia had to do with “an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin in the palm of the hands.” These nerve endings are located on arteriole-venule shunts on blood vessels.

What does this mean?

The shunts play a key role in supporting blood flow between skin and muscle in thermal regulation–the temperature control in the body, which is just like the thermostat in your home that keeps your temperature comfortable.

Dr. Charles Argoff, MD

The abnormalities in these shunts or “thermostats” of the body can cause decrease oxygen transportation to the muscle, resulting in widespread pain and fatigue.

I spoke with both researchers and they are excited that these new findings will lead to a better acceptance of fibromyalgia as a “real” disease and hopefully lead to new and better therapies.

What do all these new findings mean?

My take away to my patients and readers: you aren’t crazy, there is a medical problem. Our practice does help ease the pain with medications, vitamin therapy, gamma globulin therapy, and hopefully, in the near future, we will conquer this difficult condition.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island