Fomyalgia
For Fibromyalgia Patients
Research from Massachusetts General Hospital suggests that some cases of fibromyalgia
have a neurological cause.
Neurology faculty members Anne Louise Oaklander, MD, PhD and Max Klein PhD and their
team have published two studies suggesting that at least half of patients with fibromyalgia – a
common cause of widespread chronic pain and other symptoms – have evidence of a
neurological disease called small-fiber polyneuropathy (SFPN). Their publications in prominent
peer-reviewed journals [5][4] have been widely profiled including by ABC News and USA
Today. These findings, confirmed by other laboratories [1;6;7], are the first pathological
abnormalities found in fibromyalgia patients. Until now fibromyalgia has been a label based on
symptoms alone, meaning no possibility of treating the underlying causes. The new findings
linking fibromyalgia to SFPN may make that possible since SFPN is caused by underlying
medical conditions that can sometimes be identified and treated effectively [2].
How can fibromyalgia patients get tested for SFPN?
The published studies used skin biopsies to identify those fibromyalgia patients who seemed to
have SFPN. This involves removing one or more tiny skin samples of anesthetized skin from
patients’ lower leg and counting the nerve endings within. Low numbers objectively
demonstrate damage to the small-fiber nerve endings. This test is endorsed for SFPN diagnosis
by the American Academy of Neurology [3].
There are two ways to get skin biopsy analysis at MGH. All patients not already registered
at MGH must phone 1-866-211-6588 to register and provide insurance information.
1. For patients able to travel to MGH, their physician can refer them to have skin biopsy
performed and analyzed at MGH by submitting this requisition form.
2. For distant patients unable to travel to MGH, their physician can perform the skin biopsies in
their own offices and ship them to MGH for interpretation and a Pathology report. To
arrange to ship skin biopsies to MGH for analysis, call Heather Downs at 617-726-0260.
What if skin biopsy suggests that you have small-fiber polyneuropathy (SFPN)?
Identifying the cause of SFPN can help doctors and patients choose better treatments, so we
recommend that patients with skin biopsies interpreted as SFPN seek advice from nerve
specialists to look for its underlying causes. Potentially treatable causes of SFPN include
diabetes, vitamin deficiencies, toxins, autoimmunity, and cancers. Targeted treatment may
permit nerves to heal and symptoms to improve. Most large hospitals have neurologists who
specialize in peripheral nerve disorders. For an appointment with MGH’s nerve specialists,
phone 855-644-6387.
"Until now, there has been no good idea about what causes fibromyalgia, but now we have
evidence for some but not all patients. Fibromyalgia is too complex for a 'one size fits all'
explanation so we are continuing our research" says Oaklander, an Associate Professor of
Neurology at Harvard Medical School. This research on fibromyalgia was possible because of
the generosity of individual donors and foundations. For information about how to contribute to
Fomyalgia
For Fibromyalgia Patients
support this ongoing work, contact the MGH Development Office at 617-643-0447 or e-mail
sfitzgibbons@partners.org.
Reference List
View Dr. Oaklander's Publications on PubMed
[1] 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;14:895-915.
[2] Amato AA, Oaklander AL. Case records of the Massachusetts General Hospital. Weekly
clinicopathological exercises. Case 16-2004. A 76-year-old woman with numbness and
pain in the feet and legs. N Engl J Med 2004;350:2181-2189.
[3] England JD, Gronseth GS, Franklin G, Carter GT, Kinsella LJ, Cohen JA, Asbury AK,
Szigeti K, Lupski JR, Latov N, Lewis RA, Low PA, Fisher MA, Herrmann DN, Howard
JF, Jr., Lauria G, Miller RG, Polydefkis M, Sumner AJ. Practice Parameter: Evaluation of
distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy
(an evidence-based review). Report of the American Academy of Neurology, American
Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of
Physical Medicine and Rehabilitation. Neurology 2009;72:177-184.
[4] Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber
polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain 2013.
Fomyalgia
For Fibromyalgia Patients
[5] Oaklander AL, Klein MM. Evidence of small-fiber polyneuropathy in unexplained,
juvenile-onset, widespread pain syndromes. Pediatrics 2013;131:e1091-e1100.
[6] Solà R, Collado A, Antonelli F, Quiles C, Serra J. Is fibromyalgia a special type of small
fiber neuropathy? A microneurography study. Meeting of the International Association for
the Study of Pain 2012.
[7] Üçeyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, CasanovaMolla J, Reiners K, Sommer C. Small fibre pathology in patients with fibromyalgia
syndrome. Brain 2013.