Definitions

What is Fibromyalgia?

Fibromyalgia: According to the Mayo Clinic:
“Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals.”

Fibromyalgia can be primary, or secondary to another serious illness such as Cancer, Lupus and Rheumatoid Arthritis. Since Fibromyalgia is a diagnosis of exclusion, it is essential to rule out other serious illnesses. It is diagnosed by a clinical history of pain in all four quadrants of the body for a period of no less than 3 months.

According to the CDC:
“The most common symptoms of Fibromyalgia are
Pain and stiffness all over the body
Fatigue and tiredness
Depression and anxiety
Sleep problems
Problems with thinking, memory, and concentration
Headaches, including migraines
Other symptoms may include:
Tingling or numbness in hands and feet
Pain in the face or jaw, including disorders of the jaw known as temporomandibular joint syndrome (also known as TMJ)
Digestive problems, such as abdominal pain, bloating, constipation, and even irritable bowel syndrome (also known as IBS)”

Small Fiber Neuropathy
Small Fiber Neuropathy —is considered responsible for up to half of Fibromyalgia cases.
According to the National Institutes of Health:
https://www.ncbi.nlm.nih.gov/books/NBK582147/
“Small fiber neuropathy presents with burning pain, often beginning in the extremities, most notably in the feet. It is due to the involvement of A-delta and C nerve fibers. It may occur idiopathically or due to metabolic, hereditary, infectious, immune-mediated, or toxic etiologies. It must be promptly diagnosed and treated to avoid pain, debility, or possible large nerve fiber involvement….

Small fiber neuropathy affects the small myelinated Aδ-fibers as well as the unmyelinated C-fibers.[4] SFN may affect both sensory and autonomic fibers, leading to sensory changes, autonomic dysfunction, or a combination of symptoms.[5] The autonomic small nerve fibers transmit thermoregulatory, cardiovascular, gastrointestinal, sudomotor, urogenital, and other autonomic signals, while the somatic small nerve fibers transmit information regarding pain, temperature, and itch.[6]

General symptoms of SFN include fatigue, cognitive disturbances, headache, and widespread musculoskeletal pain, and thus may negatively impact their quality of life. SFN is associated with a multitude of diseases; however, it may also present idiopathic. “ Small Fiber Neuropathy is confirmed by biopsy, generally of the leg and arm.

NIH: Small-fiber neuropathy causes some ill-defined multi symptom illnesses:
https://www.va.gov/RAC-GWVI/meetings/apr2017/Oaklander.pdf

Anne Louise Oaklander | Small Fibers, Big Pain || Radcliffe Institute — https://www.youtube.com/watch?v=s66LvWQ5Qso

Small Fiber Polyneuropothy—includes autonomic and sensory systems. Fibromyalgia and Small Fiber Neuropathy or Polyneuropathy can co-exist. A biopsy can confirm SFN. Those who are affected in the autonomic nervous system may experience many symptoms including blood pressure and heart rates that can quickly move up and down in extremes, and abnormalities with balance, sweat, and smell. Research focuses on innervation of blood vessels affecting blood flow or lack of it, to areas such as the brain. This may be responsible for what is known as Fibro Fog.

Following pain, Chronic Fatigue is perhaps the second most common complaint of those with Fibromyalgia. While there are a variety of remedies, both pharmacological and non-pharmacological, for treating pain, little is known about treating the often debilitating fatigue of Fibromyalgia. These patients are also sometimes exercise-intolerant. Chronic Fatigue Syndrome (CFS) is also called Myalgic Encephalomyelitis (ME) or ME/CF. Physicians and patients who are interested in learning more can follow the latest research published by Cort Johnson called “Health Rising.” Health Rising by Cort Johnson. Finding Answers for ME/CFS and FM
https://www.healthrising.org

Pre-Diabetes and Small Fiber Neuropathy:
https://www.hopkinsmedicine.org/news/publications/hopkins_medicine_magazine/features/
fall-2016/the-fire-within

NIH National Library of Medicine:
“Small fiber neuropathy is the result of damage to peripheral nerves,1 including those that are small and myelinated (Aδ), as well as those that are unmyelinated (unmyelinated C fibers).2 In SFN, small somatic and autonomic fibers can be affected.1 Normally, these fibers control thermal and pain perception and control autonomic and enteric functions. For this reason, patients with SFN can present with either autonomic or somatic symptoms, or both. Symptoms are potentially numerous and can include allodynia, burning, lower thermal sensation, hyperesthesia, paresthesia, numbness in the lower extremities with potential to affect limbs and trunk, restless leg syndrome, dry eyes and mouth, abnormal sweating, bladder control issues, gastric issues, skin discoloration, and cardiac symptoms.3 Cardiac symptoms include syncope, palpitations, and orthostatic hypotension. Even without diffuse autonomic dysfunction, a percentage of patients with postural orthostatic tachycardia syndrome (POTS) can have SFN.Small fiber neuropathy has a poorly understood pathology. It can be a result of a variety of diseases, including diabetes mellitus, autoimmune disorders such as Sjögren or sarcoidosis, paraproteinemia, and paraneoplastic syndrome, with diabetes mellitus being the most common cause of SFN (Table 1).1,3 Hereditary amyloid neuropathy also results in damage to small nerve fibers.4 Amyloid neuropathies can be multisystemic or relegated to the cardiac system or only neuropathy.5,6 There can be some presentation of neuropathy and cardiac symptoms without being widespread. Familial amyloid neuropathies include those caused by mutations in transthyretin (TTR) amyloidosis, apoprotein A1, and gelsolin.4”

Central Sensitization: Dr. Daniel Clauw, University of Michigan.
https://www.youtube.com/watch?v=sQcJFSUq0Vg
“Central sensitization contributes to neuropathic and inflammatory pain, migraine, and irritable bowel syndrome.In these patients, it is involved in producing abnormal responsiveness to noxious and innocuous stimuli and a spread of tenderness beyond lesion sites. Central sensitization may also play a fundamental role in the abnormal and widespread pain sensitivity in patients with fibromyalgia. Given the major role of central sensitization in the generation of clinical pain hypersensitivity, it is essential that we understand the triggers and mechanisms responsible for the induction and maintenance of the switch in the somatosensory system from the physiological state, in which the sensory experiences evoked by low-intensity stimuli (innocuous sensations) and noxious stimuli (pain) are quite distinct and separate, to a
dysfunctional hypersensitive system in which this discrimination is lost.”
Central Sensitization: National Library of Medicine, NIH: https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2750819/

Allodynia “is pain due to a stimulus that does not normally elicit pain.” Cleveland Clinic

Hyperalgesia “is increased pain from a stimulus that normally provokes pain.” —Cleveland
Clinic