Fibromyalgia (FM) Cases with Tingly, Funny Feelings – How Can You Tell If You Have a Small Fiber Neuropathy Instead?

There is evidence that a small fiber neuropathy is responsible for a subset of FM cases – particluarly if there is more burning, numb feelings and  severe pain (neuropathic symptoms). A group with these symptoms was biopsied but predicting who would have a small fiber neuropathy was not necessarily possible.

Int J Neurosci. 2013 Jan;123(1):38-41.
Usefulness of skin biopsies in the evaluation and management of patients with suspected small fiber neuropathy.
Saperstein DS, Levine TD, Levine M, Hank N. abstract here

I have previously written how small fiber neuropathy is common in FM:
|Is Fibromyalgia(FM) a Small Fiber Neuropathy?

One study documented that 76% of their FM cases complained of “paresthesias” – numb funny feelings:

A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg
X. J. Caro, E. F. Winter and A. J. Dumas
Rheumatology 2008;47;208–211  free article here

The article  even went so far is to find that a further subgroup of thier patients with abnormal nerve studies actually had something called Chronic Inflammatory Demyelinating Polyneuropathy and this condition can respond to Immunoglobulin infusions.

In original top article, they found

  • “patients had sensory symptoms of numbness or dysesthetic sensations such as burning or stinging”
  • At least 1/2 of cases had pain

Investigations included:

They found

  • impaired glucose tolerance (17%),
  •  diabetes mellitus (8%),
  • vitamin B12 deficiency (7%),
  • ethanol abuse (4%).
  • 2 biopsy sites – proximal thigh and distal calf

Results by whether or not Biopsies were positive:

Features suggestive there is a small fiber neuropathy included:

  • Twice as likely to have pain symptoms – that would include all of Fibromyalgia patients though
  • length dependent symptoms (more symmetrical distal stocking glove pattern)
  • Facial symptoms would make it more likely FM – (I do see facial numbness with scalene spasms affecting upper cervical anterior plexus)
  • Biopsies were read by  Therapath (New York, USA) – has developed quite a reputation
  • They found with a positive biopsy, response to neuropathic agents was twice as likely (84% versus 42%)

Comment – Fibromyalgia patients with significant tingling  issues might want to consider getting tested – it would mean biopsies sent to the USA at your expense. Having said that, most labs can do proper counts:
Journal of the Neurological Sciences Volume 228, Issue 1 , Pages 65-69, 15 January 2005
The reliability of skin biopsy with measurement of intraepidermal nerve fiber density
A. Gordon Smith et al  abstract here

found good comparison between labs

Comment – Fibromyalgia is a denigrated disease and many victims feel that acutely – finding one has a small fiber neuropathy instead would help there. It might help against insurance companies, legitimising one’s complaints. In our province, it would allow access to Lyrica, should tricyclics (which if one looks closesly at the literature does poorly in neuropathic pain) fail. The idea of FM being one disease is quickly becoming history.

This entry was posted in Fibromyalgia. Bookmark the permalink.

One Response to Fibromyalgia (FM) Cases with Tingly, Funny Feelings – How Can You Tell If You Have a Small Fiber Neuropathy Instead?

  1. Anonymous says:

    2004 I came down with CMV…Cytomegalovirus
    which left me with CFS…Chronic Fatigue Syndrome.
    2007 FMS…Fibromyalgia Syndrome.
    2009 Type 2 Diabetic
    2010 Hi blood pressure
    2011 Glaucoma
    During CMV I had burning, with intermitten flashes of stabbing pain in 3 areas which would startle me to jump & then grab the spot.
    The three areas were:
    1) The intercostobrachial nerve area under the left arm
    2) Under the last rib on the outside of the right side
    3) The groin on the right leg
    These neuropathic pain areas still return today at unknown times, although not as often when the CMV was positive.
    I still have CFS & FMS.
    Is there HOPE for these sharp, shooting pains or anything new for the other problems?
    Thank you.. (female) age 68

Leave a Reply

Your email address will not be published.