“Fibro Myalgia” it means pain of muscle fibers, and it is what it is: pain, which gradually become widespread, and intense fatigue. A very common disease but do not expect much help from the doctors, who do not like it much. Yet a new track was born.
When you have fibromyalgia … we suffer! Pains ; who are spreading gradually to all the joints and the muscles. It often persists for months and, in the most extreme situations, we can not even touch the body because of the pain it causes. Cause or consequence, are superimposed an enormous fatigue and sleep disorders. This looks a bit like aches that would last a lifetime! But it is a disease that affects about 1 million French; a disease perfectly recognized by the World Health Organization, which remains controversial.
Controversial, because one does not know the causes! There is nothing that could explain the pain and the fatigue. Nothing on the radio, MRI or blood sampling.
It is hereditary? It’s genetic? It’s shrink? Where did this come from ?
If we knew where the source is located, we already have a track! jumble could be cited, muscle abnormalities, viral infection, hormonal disorders, hypersensitivity to pain … Nothing has been proved. And the disease is often connected to an initiating event: a stress or trauma. This explains why it often ends to the shrink. Without much effect.
Doctors floundering. Among those who go a little faster at the psychiatric case and those who are bent on batteries of tests that are useless. It is a disease that in all approaches, costly to the community. Meanwhile … the patient suffers.
Then the doctor gives medicine against symptoms. Against pain, against poor sleep, against the morale … It stacks the drugs and side effects, without treating the disease … Because we can not do it.
Fibromyalgia is almost unknown in Europe, while in the United States, it accounts for almost one in ten cases notified disability. Why put a name to a disease if we do not know the deal?
Because it changes everything! First stop for the “medical nomadism”, as these are patients who go from doctor to doctor. It is estimated that it takes an average of 6 years. To save money and help to open up relaxation techniques that can relieve, much better than drugs.
A new hopeful track
A team has discovered that autoimmunity targeting small nerve fibers can cause chronic pain. Immunoglobulin injections improve pain.
A study in some pain secondary to chronic syndromes lesions of small terminal nerve fibers shows that some of these cases are caused by an autoimmune disease. The study also provides the first effective treatment option for this disease.
This pilot study of 55 patients diagnosed with what appears to be an autoimmune polyneuropathy small fiber (SFPN) shows that treatment with intravenous immunoglobulin used to treat other autoimmune diseases, relieves pain in 75% of patients .
“This is the first treatment that has the potential to really improve nerve damage, not just to block the pain with drugs such as opioids or psychotropic drugs and do not treat the cause,” says Dr. Anne Louise Oaklander, director of the department of neurology at Massachusetts General Hospital and lead author of an article published receiving early online in the journal Therapeutic Advances in neurological Disorders . “This is a study proof of concept showing that the modulation of the immune system can be effective to treat a small nerve fibers apparently autoimmune, a disease which most painful patients do know not achieved “.
Achievement of small nerve fibers
This new disease consists of lesions specifically affecting the tiny nerve fibers that transmit pain signals or control internal body functions such as heart rate, blood pressure and sweating (autonomic nervous system).
Patients with the disease often develop chronic pain, fatigue, weakness or discomfort when standing, rapid heart rate, or gastrointestinal problems.
The causes of this disease currently known small nerve fibers include diabetes, other autoimmune diseases, infections such as Lyme disease and certain viruses and chemotherapy, but this article has focused on the 30 to 50% painful patients in whom no cause was found at their first assessment, leading to a diagnosis of syndrome of small nerve fibers “idiopathic”.
Previous studies of the group of Oaklander and other teams have suggested that some of these patients have an autoimmune disease underlying and undiagnosed.
Finally an origin for pain
In a study published in 2013 in Pediatrics , the team of Oaklander presented the first evidence of an autoimmune origin in some cases of reach of small nerve fibers syndrome in children and adolescents.
While these healthy young people had no medical explanation for their achievement of small fibers, the researchers noted that many had personal or family history of autoimmune diseases or immune / inflammatory activation markers. These and other evidence has led the team to propose the existence of an infringement syndrome small original nerve fibers autoimmune disease in which the immune system directly attack the small nerve fibers.
Several other types of nerve damage caused by autoimmune attacks are already known: against the nerve roots in the Guillain-Barre syndrome or against large nerve fibers in systemic autoimmune diseases such as rheumatoid arthritis and lupus, diseases which have also been also associated with the syndrome reached the small nerve fibers.
Interest gamma globulin
The study Oaklander 2013 in Pediatrics was also reported that treatment with steroid drugs, or immunoglobulins was able to improve 12 of the 15 children treated.
The effectiveness of corticosteroids is also demonstrated in some other publications, but their long-term use due to side effects.
The current study was carried out with a treatment with intravenous immunoglobulin, an approved treatment in a variety of immune disorders that can be prescribed off-label for other immune diseases.
The team examined the medical records of 55 chronic pain patients at Massachusetts General Hospital meet the diagnostic criteria of the reach of small nerve fibers syndrome, and showing no known cause at current diagnostics. These patients were treated with intravenous immunoglobulin at a starting dose of 2 grams per kilogram of weight every four weeks.
All but four were treated for at least three months. The four who left did so because of intolerance to immunoglobulins. The treatment efficacy analysis was based on new types of validated criteria, which have been improved: 74% of 51 patients noted that their pain and their symptoms had improved after treatment, as 77% of their doctors. In 8 patients, the symptoms are so improved that they were able to gradually reduce any associated processing and finally to interrupt.
All of a revolution
According to Professor Oaklander, “although this is not a controlled clinical trial, the results are so surprising that they are changing paradigm in this disease because the fact that an immunomodulatory treatment is as effective is the strongest evidence that some people with chronic pain related to a syndrome of reach of small fibers have an autoimmune cause that can be treated. ”
Although immunotherapy is not indicated for all pain syndromes with involvement of small nerve fibers, those with idiopathic form must now be systematically screened for all known causes, as well as autoimmune cause and discuss immunoglobulin IV.
This pilot study should be validated in a prospective controlled clinical trial that is being organized. Develop knowledge about the autoimmune causes still unknown which affects some small nerve fibers should lead to identifying more specific immunological mechanisms and lead to less expensive and easier to manage than immunotherapies intravenous immunoglobulin. In France, the diagnosis of chronic pain syndrome associated with lesions of the small nerve fibers can be done on various examinations including SUDOSCAN and skin biopsy to analyze the density of small terminal nerve fibers in the skin.