Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;37(12):3167-3171.
doi: 10.1007/s10067-018-4300-2. Epub 2018 Sep 20.

Fibromyalgia and Small Fiber Neuropathy: The Plot Thickens!


Fibromyalgia and Small Fiber Neuropathy: The Plot Thickens!

Manuel Martínez-Lavín. Clin Rheumatol. .


Several groups of investigators have described the presence of small fiber neuropathy in fibromyalgia patients. This writing discusses how this new finding could renovate fibromyalgia concept, diagnosis, and treatment. Predominant rheumatology thinking proposes fibromyalgia as a "centralized pain syndrome." An alternative hypothesis views fibromyalgia as a stress-related dysautonomia with neuropathic pain features. Dorsal root ganglia may be the key autonomic-nociceptive short-circuit sites. The recent recognition of small fiber neuropathy in a large subgroup of fibromyalgia patients reinforces the dysautonomia-neuropathic hypothesis and validates fibromyalgia pain. These new findings support fibromyalgia as a primarily neurological entity, nevertheless, rheumatologist will likely remain the best equipped specialist to diagnose fibromyalgia and differentiate it from other multi-symptomatic rheumatic syndromes. Skin biopsy and corneal confocal microscopy will probably become useful fibromyalgia diagnostic tests. Dorsal root ganglia sodium channel blockers are potential fibromyalgia analgesic medications. Subgroups of young girls with "autoimmune neuropathic fibromyalgia" may respond to immunoglobulin therapy. Multimodal intervention directed to regain autonomic nervous system resilience will likely remain the cornerstone for fibromyalgia therapy.

Keywords: Dorsal root ganglia; Dysautonomia; Fibromyalgia; HPV vaccine; Postural orthostatic tachycardia syndrome; Small fiber neuropathy; Sodium channels; Sympathetic pain.

Similar articles

See all similar articles

Cited by 4 articles


    1. Pain. 2015 Nov;156(11):2115-6 - PubMed
    1. Pain. 2013 Nov;154(11):2310-6 - PubMed
    1. BMC Musculoskelet Disord. 2012 Feb 20;13:23 - PubMed
    1. Ann Neurol. 2014 Feb;75(2):196-208 - PubMed
    1. Clin Exp Rheumatol. 2016 Mar-Apr;34(2 Suppl 96):S9-13 - PubMed