The Confusion Surrounding Fibromyalgia, Chronic Fatigue Syndrome And Neuropathy

Today's post from verywell.com (see link below) does little to answer the question as to whether fibromyalgia and chronic fatigue syndrome are both in fact neuropathic conditions (something that has baffled the medical profession for years) but it does present the argument once again. It could equally be asked that if you have neuropathy, can you also have fibromyalgia or CHS - the question in reverse then. The point is that it seems more and more likely that neuropathic conditions can and do overlap each other, making diagnosis increasingly difficult. As the treatments tend to be similar (as shown by the somewhat limited and ill-advised drugs in this article); you could argue that the diagnosis is more for doctors than for patients - there is no cure and treatments are pretty much the same across the board, so what does it matter which label you attach? Well, as research progresses and new drugs are discovered to treat specific nerve conditions, the exact cause and form of neuropathy may be much more relevant in the future. An interesting article if you're not completely satisfied by your doctor's conclusions and diagnosis of your problem but be careful before jumping to conclusions - you may have to accept a general diagnosis of nerve damage and not worry too much about the title and concentrate on using available treatments to make you feel better.

Small Fiber Neuropathy in Fibromyalgia and CFS
By Adrienne Dellwo Updated February 01, 2018

Is the pain we feel with fibromyalgia and chronic fatigue syndrome from a type of nerve damage called neuropathy? It's an idea that's been around for several years—after all, our pain is very similar—but is garnering wider support as researchers find more evidence.

Research first presented at the American Academy of Neurology's 2010 annual meeting in Toronto suggests that many of us with these conditions have something called small fiber neuropathy—abnormalities in the small nerve fibers, which are near the surface of your skin a deal with pain and temperature sensation.

(Temperature sensitivity is an extremely common symptom of fibromyalgia and chronic fatigue syndrome.)

In this study, the researchers took skin biopsies from 30 people who had either fibromyalgia, chronic fatigue syndrome, chronic pain syndrome, or a combination of these illnesses, as well as from a control group. Of the people with the painful conditions, biopsies showed that 13 of them, or 43%, had evidence of small fiber neuropathy.

(That's a large percentage, certainly, but given the small sample size of just 30 people, it's not conclusive. It is, however, promising enough to lead to larger studies in the future.)

Dr. Devanshi Gupta, the lead researcher, says doctors should check for small fiber neuropathy via skin biopsies in patients who have the following symptoms:

Sharp, shooting pains,
Orthostatic hypotension,
Autonomic symptoms,
Skin changes related to interrupted nerve supply,
Incontinence,
Sexual dysfunction,
Or other neuropathic symptoms.

However, some doctors say that skin biopsies aren't reliable enough alone and should only be used to confirm a diagnosis based on examination and history.

You'll likely recognize several of the symptoms listed above as fibromyalgia and chronic fatigue syndrome symptoms, including the pains, orthostatic hypotension (blood pressure drop upon standing that makes you dizzy), and autonomic symptoms.

The overlap of symptoms can make it harder to diagnose small fiber neuropathy based on symptoms and an exam alone, so the biopsy may be more useful for confirming the diagnosis in us than in the general population.

Perspective

More evidence is mounting to support the theory that these conditions, or at least a large subgroup of them, are neuropathic. The prevalence of intense nerve pain, strange nerve sensations, and abnormal nerve response all point that direction, as does the fact that many of us are helped by treatments aimed at neuropathy, such as Lyrica (pregabalin) and Neurontin (gabapentin) (both of which have potential serious side effects Ed:). Checking for small fiber neuropathy may help doctors determine which of us are likely to respond to these kinds of treatments.

So if this research is accurate and just under half of us have this type of neuropathy, what does that mean for the rest of us? That's something that'll need to be explored further, but that exploration will be much simpler if they can exclude the subgroup with small fiber neuropathy. We know we're not all alike, and the more we can be accurately subgrouped, the sooner we'll be able to find real answers to our many questions.

Source:

Gupta D, Harney J. Small fiber neuropathy demonstrated in pain syndromes. Poster session presented at Annual Meeting of the American Academy of Neurology; 2010 Apr 10-17; Toronto, Ontario.

https://www.verywell.com/neuropathy-in-fibromyalgia-cfs-3973033