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Updated: Jun 2, 2025
Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
Small Fibre Pathology in Fibromyalgia: A review
Anne Marshall1, Mohamed Elshafei1, Frank G Preston1,2
1Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, University Hospital Aintree, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, L9 7AL, UK.
Abstract:
Fibromyalgia syndrome (FMS) presents a complex and challenging disorder in both the diagnosis and treatment, with emerging evidence suggesting a role of small fibre pathology (SFP) in its pathophysiology. The significance of the role of SFP in FMS remains unclear; however, recent evidence suggests degeneration and dysfunction of the peripheral nervous system, particularly small unmyelinated fibres, which may influence pathophysiology and underlying phenotype. Both skin biopsy and corneal confocal microscopy (CCM) have consistently demonstrated that ~ 50% of people with FMS have SFP. CCM, a non-invasive measure of small nerve fibres has detected small fibre loss, correlating with neuropathic pain descriptors. Additionally, quantitative sensory testing has shown abnormalities, primarily in pain pressure/mechanical pain thresholds. This narrative review provides a comprehensive understanding of the pathophysiological dimensions of FMS with a clear focus on small nerve fibres and the peripheral nervous system, offering a roadmap for future research.
Insights
Small fibre pathology (SFP) is increasingly linked to fibromyalgia syndrome (FMS), affecting nearly 50% of patients. This review explores SFP
Area of Science:
- Neurology
- Pathophysiology
- Pain Medicine
Background:
- Fibromyalgia syndrome (FMS) is a complex disorder with unclear pathophysiology.
- Emerging evidence suggests small fibre pathology (SFP) plays a role in FMS.
- SFP involves degeneration and dysfunction of small unmyelinated peripheral nerve fibres.
Purpose of the Study:
- To provide a comprehensive understanding of FMS pathophysiology.
- To focus on the role of small nerve fibres and the peripheral nervous system in FMS.
- To offer a roadmap for future research in FMS and SFP.
Main Methods:
- Review of existing literature on SFP in FMS.
- Discussion of diagnostic methods including skin biopsy and corneal confocal microscopy (CCM).
- Analysis of quantitative sensory testing findings.
Main Results:
- Approximately 50% of individuals with FMS exhibit SFP.
- CCM detects small fibre loss in FMS patients, correlating with neuropathic pain.
- Abnormalities in pain pressure and mechanical pain thresholds are observed.
Conclusions:
- SFP is a significant finding in a substantial portion of FMS patients.
- Peripheral nervous system involvement, particularly SFP, is crucial to FMS pathophysiology.
- Further research is warranted to elucidate the full impact of SFP on FMS phenotypes and treatment.
