The challenge of differentiating fibromyalgia from small-fiber neuropathy in clinical practice

Bailly, Franck

doi:10.1016/j.jbspin.2021.105232

Cited by 24 publications

(5 citation statements)

References 54 publications

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“…Furthermore, we found a decrease in the intraepidermal innervation of fibromyalgia microbiota-recipient mice. The functional role of reduced density of intraepidermal fibers, which has been linked to immunological and metabolic disturbances, in mediating pain and other phenotypes in fibromyalgia is not well understood [16][17][18][19] . Together, our findings highlight the complex and multifactorial effects of fibromyalgia microbiota across several systems in mice.…”

Section: Discussionmentioning

confidence: 99%

Gut microbiota promotes pain in fibromyalgia

Cai,

Haddad,

Haddad

et al. 2023

Preprint

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Fibromyalgia is a chronic syndrome characterized by widespread pain in the absence of evident tissue injury or pathology, making it one of the most mysterious chronic pain conditions. Despite affecting 2–4% of the population, primarily women1, the cause and underlying mechanisms of fibromyalgia remain elusive, and effective targeted treatments are currently unavailable. The gut microbiota of women with fibromyalgia differs from healthy controls2,3. However, it is unknown whether changes in gut microbiota have a causal role in mediating pain and other symptoms of fibromyalgia. Here, we show that fecal microbiota transplantation (FMT) from individuals with fibromyalgia, but not from healthy controls, into germ-free mice induces persistent pain hypersensitivity. FMT from fibromyalgia patients led to a reduction in intraepidermal nerve fiber density and alterations in the peripheral immune profile, and induced activation of spinal microglia, which contributed to the development of pain in mice. Notably, the pain hypersensitivity in mice that were administered microbiota from fibromyalgia patients resolved after FMT from healthy controls. Consistent with these findings, an open-label pilot study showed that transplanting microbiota from healthy individuals to humans with fibromyalgia alleviated pain and reduced overall symptom severity. Thus, altered gut microbiota has a causal role in fibromyalgia pain, highlighting it as a promising target for therapeutic interventions.

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Section: Discussionmentioning

confidence: 99%

Gut microbiota promotes pain in fibromyalgia

Cai,

Haddad,

Haddad

et al. 2023

Preprint

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“…Thus, in SS it is very important to differentiate chronic pain due to FM or due to small fibre neuropathy. In small fibre neuropathy pain is related to loss or dysfunction of intraepidermal small nerve fibres, and neurological symptoms include paraesthesia, allodynia, sicca symptoms, warm or cold hypoesthesia whereas headache points toward FM (16).…”

Section: Rheumatology Unit Department Of Medicine University Of Udine...mentioning

confidence: 99%

The 5th International Congress on Controversies in Fibromyalgia

Ablin

Sarzi‐Puttini

2023

Clinical and Experimental Rheumatology

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Background. Fibromyalgia (FM) is characterized by chronic generalized pain. Its etiology is not completely understood at present and there are few effective treatments.Objective. The aim of this study was to investigate a possible relationship between chronic pain and gastrointestinal disorders (GID) with particular attention to the presence of GID in FM patients. Methods. Chronic pain patients (n=122) were enrolled; n=103 suffered FM, n=19 suffered other chronic pain (CP) syndromes. 92% were females, 8% males. Self-administered questionnaires were used: Global Assessment of Improvement Scale (GAI) and Symptom Severity Scale (SSS) to assess GID; Visual Analogue Scale (VAS) to measure pain intensity; Widespread Pain Index (WPI) to quantify the extent of widespread pain throughout the body; Symptom Severity (SS) scale to assess features of centralized pain in subjects with painful conditions. Results. VAS was higher in FM than CP (6.8 vs. 4.6, p0.001). WPI was 13.9 and SS 7.2 in FM subjects. GID was reported by 75 of the FM patients and by 4 of the CP ones. GAI was lower (worse) in FM than in CP subjects (30.35 vs. 41.00). Conclusion. Subjects with FM have a high prevalence of gastrointestinal complaints that should be carefully assessed due to the possible effect of GI conditions on health. Appropriate treatment of GID would improve the patients` symptoms, although this approach requires further study.

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“…The clinical findings and diagnostics tests that can help to differentiate between both should be better defined and further developed. Together with a better understanding of the pathophysiology, it will facilitate to start appropriate treatment in time [37 ▪ ].…”

Section: Syndromic Small Fiber Neuropathymentioning

confidence: 99%

“…The presence of neuropathic pain in both fibromyalgia and SFN can make it challenging to differentiate between these conditions, especially when SFN patients present with a nonlength dependent pattern [37 ▪ ]. An additional complicating factor is that diagnostic tests to detect small fiber pathology can also be abnormal in fibromyalgia.…”

Section: Syndromic Small Fiber Neuropathymentioning

confidence: 99%

Small fiber neuropathies: expanding their etiologies

Hoeijmakers

Merkies

Faber

2022

Current Opinion in Neurology

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Purpose of reviewSeveral conditions have been associated with the development of small fiber neuropathy (SFN). The list of metabolic, immune-mediated, infectious, toxic, drugs-related, and hereditary conditions is still growing and various hypotheses are made about the underlying pathophysiological mechanisms. Understanding these processes is important to provide new targets for treatment. In addition, the specific SFN phenotype can provide direction for the underlying etiology. This review discusses the latest developments concerning the expanding etiologies in SFN. Recent findingsIn the past 18 months, special attention has been paid to immunological etiologies, partly due to the coronavirus disease 2019 pandemic, but also new auto-antibodies in SFN have been demonstrated. Identifying patients with immune-mediated SFN can be challenging, since contrary to the classical distal sensory phenotype, a nonlength-dependent pattern is more common. Besides the etiologies of classical SFN, small fiber pathology is increasingly described in diseases without the typical neuropathic pain features of SFN, sometimes called syndromic SFN. However, the clinical relevance is not yet fully understood.

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The challenge of differentiating fibromyalgia from small-fiber neuropathy in clinical practice

Cited by 24 publications

References 54 publications

Gut microbiota promotes pain in fibromyalgia

Gut microbiota promotes pain in fibromyalgia

The 5th International Congress on Controversies in Fibromyalgia

Small fiber neuropathies: expanding their etiologies

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