Lee Rannals for redOrbit.com — Your Universe Online
Doctors have been able to determine the source of pain in the skin of patients who suffer from fibromyalgia.
Fibromyalgia, a widespread deep tissue pain, affects about ten million people in the US. The condition causes tenderness in the hands and feet, fatigue, sleep disorders and cognitive decline. For years, the disorder was believed to be imaginary and often even attributed to patients making up the illness. The latest research not only proves its existence, but it has also pinpointed the source.
“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,” said Dr. Rice, President of Intidyn and the senior researcher on the study published in the journal American Academy of Pain Medicine. “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.”
The team analyzed the skin of one patient who lacked all the numerous varieties of sensory nerve endings in the skin that supposedly accounted for highly sensitive and a richly-nuanced sense of touch. This patient had normal function in day-to-day tasks, but the only sensory endings the team detected were those around the blood vessels.
“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.
The team used a unique microscopic technology to study small skin biopsies collected from the palms of fibromyalgia patients who were being diagnosed and treated. They found an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin. These critical sites are tiny muscular valves known as arteriole-venule (AV) shunts.
“The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature,” Rice explained.
These shunts are unique to the palms of hands and soles of feet, working like a radiator in a car. Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, while in cold conditions the shunts open wide to allow blood to bypass the capillaries in order to conserve heat.
Dr. Phillip J. Albrecht, another researcher on the project, said the excess sensory innervation might explain why fibromyalgia patients have especially tender and painful hands.
“But, in addition, since the sensory fibers are responsible for opening the shunts, they would become particularly active under cold conditions, which are generally very bothersome to fibromyalgia patients,” Albrecht said.
Rice added that the hands and feet act as a reservoir from which blood flow can be diverted to other tissues in the body, such as muscles when we begin to exercise.
“Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body,” the researcher said.
This discovery of a distinct tissue pathology demonstrates that fibromyalgia is not imaginary, which helps to change the clinical opinion of the disease and guide future approaches for better treatments.
“Wow crazy how spot on they were it has affected me cognitively as well as sleep issues! Mine is brought on by especially cold temperatures,” Amy P, who suffers from fibromyalgia, told redOrbit. “Also my handwriting has greatly suffered. But I believe that’s because I may have tendinitis of some sort.”
Dutch researchers reported a study earlier this month contradicting these findings, saying that weather conditions do not affect fibromyalgia pain or fatigue.
“Our analyses provide more evidence against, than in support of, the daily influence of weather on fibromyalgia pain and fatigue,” said Ercolie Bossema, Ph.D. from Utrecht University in the Netherlands. “This study is the first to investigate the impact of weather on fibromyalgia symptoms in a large cohort, and our findings show no association between specific fibromyalgia patient characteristics and weather sensitivity.”
However, researchers from the recent study point to the blood flow as proof the weather does actually have an effect on fibromyalgia patients.
“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,” Rice said.