Tuesday, June 25, 2013

Dear Dr. Albrecht, Dr. Behm, Dr. Ge Hy, and Dr. Oaklander - Are these studies related?

Is there a possibility that the small-fiber polyneuropathy explains palmer AV Shunt in FM?
Could the disruptions be due to immune disruption?
How would this affect sustenance of MTrP treatments?

Dear Dr. Albrecht, Dr. Behm, Dr. Ge Hy, and Dr. Oaklander,

[Dr. Oaklander], is there a possibility that small-fiber polyneuropathy, which you and your team found in fibromyalgia, contributes to the enervation of arterioles and venules (AV shunt) in the palms of fibromyalgia patients causing them to behave erratically, as found by Dr. Albrecht’s team? Personally,  I have always felt that Raynaud’s and symptoms reported that are compatible with levido reticularis have more than a casual connection to fibromyalgia. 

This leads me to the next question, “Could this be occurring due to the unique immune pattern found in the study led by Dr. Behm?”

In my thinking, two of the studies, Dr. Albrecht and Dr Oaklander and their team, complement one another. Can we look forward to more studies regarding this possible connection?

Dr. Oaklander, you suggest that treating polyneuropathy might improve symptoms, so my next question is to Dr. Albrecht, “Could treating polyneuropathy improve the A-V shunt issue and thereby improve many symptoms having to do with body temperature control improving feedback to the brain?”

In my mind, a third possibility could be the suspected immune factor as studied by Dr. Behm and his team. Could finding and treating immune disease improve all of the above, or is it unrelated?” What is your thinking on this Dr. Behm?

One last question, “Could these disruptions explain why myofascial pain syndrome, thought to be a major pain contributor to many chronic pain disorders, be so difficult to control as a comorbid condition in fibromyalgia?” Generally, with sports injuries MTrPs are easily treated, but even a slight breeze can cause latent MTrPs in fibromyalgia patients to light up like a Christmas tree. Dr. Ge Hy, What are your thoughts on this? Could the findings of these other three teams have an effect on MTrP histology in fibromyalgia in particular?

I want to personally thank you, and I am certain I speak on behalf of all fibromyalgia patients, for all the research you are doing individually and collectively. It is validating and gives those of us who live with fibromyalgia hope. Many do not understand the impact this disorder has on a persons life.  

You know you have fibromyalgia when people say to you, 
"Nobody could have all those things at one time."

As a fibromyalgia expert at Sharecare.com, author, advocate and patient, I am interested in your thinking, and I know those I serve would be delighted to have a direct reply.

Thank You.

Sincerely, Celeste Cooper, RN

Studies and articles:

Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL. Excessive Peptidergic Sensory Innervation of Cutaneous Arteriole-Venule Shunts (AVS) in the Palmar Glabrous Skin of Fibromyalgia Patients: Implications for Widespread Deep Tissue Pain and Fatigue. Pain Med. 2013 May 20. doi: 10.1111/pme.12139. [Epub ahead of print] Pubmed abstract here.

“The excessive sensory innervation to the glabrous skin AVS is a likely source of severe pain and tenderness in the hands of FM patients. Importantly, 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. Therefore, blood flow dysregulation as a result of excessive innervation to AVS would likely contribute to the widespread deep pain and fatigue of FM. SNRI compounds may provide partial therapeutic benefit by enhancing the impact of sympathetically mediated inhibitory modulation of the excess sensory innervation.”

ARTICLE, Women with Fibromyalgia Have A Real Pathology Among Nerve Endings to Blood Vessels, at Integrated Tissue Dynamics. This is a fantastic article that explains what happens in an easy to understand analogy. See entire article here

“Scientists at Integrated Tissue Dynamics (Intidyn) and Albany Medical College have made a major discovery that should provide a more certain diagnosis of fibromyalgia, significant insight into the source and symptoms of the disease, and new strategies for its prevention and treatment. The Albany Med and Intidyn research team - headed by neurologists Charles Argoff, MD, and James Wymer, MD PhD and neuroscientists Phillip Albrecht, PhD, and Frank Rice, PhD - discovered that the skin in fibromyalgia patients has a major pathology involving nerve endings to a key type of blood vessel called arteriole-venule shunts… arteriole-venule shunts play a major role in the proper distribution of blood flow throughout the body, and the discovered pathology involving the nerve endings to the shunts provides a logical explanation for the widespread deep pain and fatigue symptomatic of fibromyalgia.

Behm FG, Gavin IM, Karpenko O, Lindgren V, Gaitonde S, Gashkoff PA, Gillis BS. Unique immunologic patterns in fibromyalgia. BMC Clin Pathol. 2012 Dec 17;12(1):25. doi: 10.1186/1472-6890-12-25. Pubmed abstract here

“The cytokine responses to mitogenic activators of PBMC isolated from patients with FM were significantly lower than those of healthy individuals, implying that cell-mediated immunity is impaired in FM patients. This novel cytokine assay reveals unique and valuable immunologic traits, which, when combined with clinical patterns, can offer a diagnostic methodology in FM.” 

The role of cytokines in FM has been studied over more than a decade.  I have never had a doubt regarding my own body that there is something askew in the immune system that accounts for the co-existence of particular disorders. Plasma levels have been consistently low, but not considered low enough to be significant.  This research is looking at specific cytokines in specific cells, in specific ways, and the results will no doubt lead research in the right direction.  I truly feel a bio-marker could be around the corner. Cc

Ge HY, Nie H, Graven-Nielsen T, Danneskiold-Sams√łe B, Arendt-Nielsen L. Descending pain modulation and its interaction with peripheral sensitization following sustained isometric muscle contraction in fibromyalgia. Eur J Pain. 2012 Feb;16(2):196-203. doi: 10.1016/j.ejpain.2011.06.008. Pubmed abstract here. 

“Descending pain modulation shifts from descending inhibition towards descending facilitation following muscle nociception in FM. Peripheral mechanical hyperalgesia and descending facilitation counterbalance the effect of descending inhibition in FM.”

MY COMMENT:This result should be no surprise in light of the stress contraction puts on a muscle when it has myofascial trigger points present. Cc

Oaklander AL, Herzog ZD, Downs H, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013 Jun 5. pii: S0304-3959(13)00294-7. doi: 10.1016/j.pain.2013.06.001. [Epub ahead of print] Pubmed abstract here

“These findings suggest that some patients with chronic pain labeled as "fibromyalgia" have unrecognized small-fiber polyneuropathy, a distinct disease that can be objectively tested for and sometimes definitively treated.”

ARTICLE: Small-Fiber Polyneuropathy Found in Fibromyalgia Patients. See entire article at Examiner.com, here.

 “Finally with the FM patients had a reduction in dermal unmyelinated nerve fibre bundles was found in skin samples of patients with fibromyalgia syndrome compared with patients with depression and with healthy control subjects, whereas myelinated nerve fibres were spared.”

1 comment:

jklarr64 said...

I have had Fibro since 1988, when they had no idea what was going on..now its to a point that everything I every enjoyed in life and pretty much came to a halt.. The pain is from my head to my feet.. muscles, joints, all of it.. I bump against a wall and it hurts for mins..like i was beat with a bat.. Im only 48 yrs old.. and Im scared what will i not be able to do or deal with this pain in 10 yrs? Tried so many pain meds.. only thing that touches the pain is Methadone, and soma.. if not for finding this combo to stop the pain.. I wouldnt have been able to make it.. I have been told its because of my depression.. NO my depression is because of living in constant pain.. not only having panic, anxiety disorder, I have now been diagnosed with depersonalization. Just one thing on top of another.. :(

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