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Nerve-related skin in hands probably caused pain in fibromyalgia patients
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Excessive sensory innervation to the glabrous skin arteriole-venule shunts likely caused severe pain and tenderness in the hands of women with fibromyalgia, according to recent study results.
“There is a physically detectable peripheral nervous system pathology that was consistently found, even in just one very small skin biopsy [about one-third the size of a pencil eraser] from each of the female fibromyalgia patients,” researcher Frank L. Rice, PhD, president and CEO of Integrated Tissues Dynamics, told Healio.com. “The nature of the pathology, involving an excess of mostly sensory fibers on cutaneous arteriole-venule shunts [AVS], provides a rationale for many of the fibromyalgia symptoms.”
Frank L. Rice
Researchers studied 24 women with fibromyalgia (FM; average age, 51 years) and 23 healthy women (controls; average age, 47 years). Due to the small size of hypothenar skin biopsies, 18 FM patients’ and 14 controls’ biopsies identified an AVS to analyze. Patient average FM intensity score (FIS) was 6 ± 2, and the average visual analog scale (VAS) was 60 ± 18 at baseline. FIS and VAS were not recorded for control participants, who reported no pain.
Multimolecular immunocytochemistry assessed cutaneous innervation types in 3 mm skin biopsies from the glabrous hypothenar and trapezius regions.
Multimolecular immunocytochemistry assessed cutaneous innervation types in 3 mm skin biopsies from the glabrous hypothenar and trapezius regions.
Among FM patients, AVS had significantly increased innervation, with overall average innervation area of AVS profiles being twice those of controls (20 x 103 mcm [2] vs. 10 x 103 mcm [2]; P<.001). Greater proportion of vasodilatory sensory fibers, compared with vasoconstrictive sympathetic fibers, constituted the excessive innervation.
“In contrast, sensory and sympathetic innervation to arterioles remained normal,” the researchers reported. “Importantly, the sensory fibers express alpha2C receptors, indicating that sympathetic innervation exerts an inhibitory modulation of sensory activity.
“Glabrous AVS regulate blood flow to the skin in humans for thermoregulation and to other tissues such as skeletal muscle during periods of increased metabolic demand,” the researchers concluded. “Therefore, blood flow dysregulation as a result of excessive innervation to AVS would likely contribute to the widespread deep pain and fatigue of FM.”
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