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Published in: Current Pain and Headache Reports 12/2015

01-12-2015 | Neuropathic Pain (E Eisenberg, Section Editor)

The Role and Importance of Small Fiber Neuropathy in Fibromyalgia Pain

Authors: Xavier J. Caro, Earl F. Winter

Published in: Current Pain and Headache Reports | Issue 12/2015

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Abstract

Serious investigators of fibromyalgia (FM) realize the profound implications of finding features of small fiber neuropathy (SFN) in this disorder. For the first time, an easily reproducible and generally agreed upon, peripheral tissue lesion has been reported from multiple investigative centers. Understanding how this discovery relates to other features of FM, and how one might utilize it to better comprehend, and care for, afflicted patients’ painful complaints remains a challenge, however. In this article we review how the SFN seen in FM may be placed in context, and suggest how such a tissue abnormality might be used to better understand the pathophysiology of FM, and plan for its effective treatment. We also suggest how finding SFN in FM implies the need for continued focused research within the area of neuropathic disease in FM.
Literature
1.
go back to reference Doppler K, Rittner HL, Deckart M, Sommer C. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain. 2015. Doppler K, Rittner HL, Deckart M, Sommer C. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain. 2015.
2.
3.
go back to reference Kosmidis ML, Koutsogeorgopoulou L, Alexopoulos H, Mamali I, Vlachoyiannopoulos PG, Voulgarelis M, et al. Reduction of intraepidermal nerve fiber density (IENFD) in the skin biopsies of patients with fibromyalgia: a controlled study. J Neurol Sci. 2014;347(1–2):143–7.CrossRefPubMed Kosmidis ML, Koutsogeorgopoulou L, Alexopoulos H, Mamali I, Vlachoyiannopoulos PG, Voulgarelis M, et al. Reduction of intraepidermal nerve fiber density (IENFD) in the skin biopsies of patients with fibromyalgia: a controlled study. J Neurol Sci. 2014;347(1–2):143–7.CrossRefPubMed
4.•
go back to reference Caro XJ, Winter EF. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: clinical and immunologic implications. Arthritis Rheumatol. 2014;66:1945–54. This study demonstrates a measureable immune component to the SFN seen in fibromyalgia.CrossRefPubMed Caro XJ, Winter EF. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: clinical and immunologic implications. Arthritis Rheumatol. 2014;66:1945–54. This study demonstrates a measureable immune component to the SFN seen in fibromyalgia.CrossRefPubMed
5.
go back to reference Giannoccaro MP, Donadio V, Incensi A, Avoni P, Liguori R. Small nerve fiber involvement in patients referred for fibromyalgia. Muscle Nerve. 2014;49:757–9.CrossRefPubMed Giannoccaro MP, Donadio V, Incensi A, Avoni P, Liguori R. Small nerve fiber involvement in patients referred for fibromyalgia. Muscle Nerve. 2014;49:757–9.CrossRefPubMed
6.
go back to reference Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013;154:2310–6.CrossRefPubMed Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013;154:2310–6.CrossRefPubMed
7.•
go back to reference Üçeyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain. 2013;136:1857–67. This ambitious study surveys SFN and function using a variety of approaches.CrossRefPubMed Üçeyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain. 2013;136:1857–67. This ambitious study surveys SFN and function using a variety of approaches.CrossRefPubMed
8.
go back to reference Blumenstiel K, Gerhardt A, Rolke R, Bieber C, Tesarz J, Friederich HC, et al. Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia. Clin J Pain. 2011;27(8):682–90.CrossRefPubMed Blumenstiel K, Gerhardt A, Rolke R, Bieber C, Tesarz J, Friederich HC, et al. Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia. Clin J Pain. 2011;27(8):682–90.CrossRefPubMed
10.
go back to reference Donadio V, Liguori R. Microneurographic recording from unmyelinated nerve fibers in neurological disorders: an update. Clin Neurophysiol. 2015;126(3):437–45.CrossRefPubMed Donadio V, Liguori R. Microneurographic recording from unmyelinated nerve fibers in neurological disorders: an update. Clin Neurophysiol. 2015;126(3):437–45.CrossRefPubMed
11.•
go back to reference Serra J, Collado A, Solà R, Antonelli F, Torres X, Salgueiro M, et al. Hyperexcitable C nociceptors in fibromyalgia. Ann Neurol. 2014;75(2):196–208. This study demonstrates that the SFN lesion in FM is not merely anatomical, but functional as well.CrossRefPubMed Serra J, Collado A, Solà R, Antonelli F, Torres X, Salgueiro M, et al. Hyperexcitable C nociceptors in fibromyalgia. Ann Neurol. 2014;75(2):196–208. This study demonstrates that the SFN lesion in FM is not merely anatomical, but functional as well.CrossRefPubMed
12.
go back to reference Caro XJ. Immunofluorescent detection of IgG at the dermal-epidermal junction in patients with apparent primary fibrositis syndrome. Arthritis Rheum. 1984;27:1174–9.CrossRefPubMed Caro XJ. Immunofluorescent detection of IgG at the dermal-epidermal junction in patients with apparent primary fibrositis syndrome. Arthritis Rheum. 1984;27:1174–9.CrossRefPubMed
13.
go back to reference Caro XJ, Wolfe F, Johnston WH, Smith AL. A controlled and blinded study of immunoreactant deposition at the dermal-epidermal junction of patients with primary fibrositis syndrome. J Rheumatol. 1986;13:1086–92.PubMed Caro XJ, Wolfe F, Johnston WH, Smith AL. A controlled and blinded study of immunoreactant deposition at the dermal-epidermal junction of patients with primary fibrositis syndrome. J Rheumatol. 1986;13:1086–92.PubMed
14.
go back to reference Caro XJ. Is there an immunologic component to the fibrositis syndrome? Rheum Dis Clin N Am. 1989;15:169–86. Caro XJ. Is there an immunologic component to the fibrositis syndrome? Rheum Dis Clin N Am. 1989;15:169–86.
15.•
go back to reference Caro XJ, Winter EF, Dumas A. A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy (CIDP) and appear to respond to IVIg. Rheumatology (Oxford). 2008;47:208–11. This study is the first to show large nerve involvement in FM and potential responsiveness to IVIg treatment.CrossRef Caro XJ, Winter EF, Dumas A. A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy (CIDP) and appear to respond to IVIg. Rheumatology (Oxford). 2008;47:208–11. This study is the first to show large nerve involvement in FM and potential responsiveness to IVIg treatment.CrossRef
16.
go back to reference Dinerman H, Goldenberg DL, Felson DT. A prospective evaluation of 118 patients with fibromyalgia syndrome: prevalence of Raynaud’s phenomenon, sicca symptoms, ANA, low complement, and Ig deposition at the dermal-epidermal junction. J Rheumatol. 1986;13:368–73.PubMed Dinerman H, Goldenberg DL, Felson DT. A prospective evaluation of 118 patients with fibromyalgia syndrome: prevalence of Raynaud’s phenomenon, sicca symptoms, ANA, low complement, and Ig deposition at the dermal-epidermal junction. J Rheumatol. 1986;13:368–73.PubMed
17.
go back to reference Smart PA, Waylonis GW, Hackshaw KV. Immunologic profile of patients with fibromyalgia. Am J Phys Med Rehabil. 1997;76:231–4.CrossRefPubMed Smart PA, Waylonis GW, Hackshaw KV. Immunologic profile of patients with fibromyalgia. Am J Phys Med Rehabil. 1997;76:231–4.CrossRefPubMed
18.•
go back to reference Salemi S, Rethage J, Wollina U, et al. Detection of interleukin 1 beta (IL-1beta), IL-6, and tumor necrosis factor-alpha in skin of patients with fibromyalgia. J Rheumatol. 2003;30:146–50. This study demonstrates abundant, local inflammatory markers in FM skin samples suggesting immune participation in FM skin pathology.PubMed Salemi S, Rethage J, Wollina U, et al. Detection of interleukin 1 beta (IL-1beta), IL-6, and tumor necrosis factor-alpha in skin of patients with fibromyalgia. J Rheumatol. 2003;30:146–50. This study demonstrates abundant, local inflammatory markers in FM skin samples suggesting immune participation in FM skin pathology.PubMed
19.
go back to reference Hernanz W, Valenzuela A, Quijada J, et al. Lymphocyte subpopulations in patients with primary fibromyalgia. J Rheumatol. 1994;21:2122–4.PubMed Hernanz W, Valenzuela A, Quijada J, et al. Lymphocyte subpopulations in patients with primary fibromyalgia. J Rheumatol. 1994;21:2122–4.PubMed
20.
go back to reference Wallace DJ, Bowman RL, Wormsley SB, Peter JB. Cytokines and immune regulation in patients with fibrositis. Arthritis Rheum. 1989;32:1334–5.CrossRefPubMed Wallace DJ, Bowman RL, Wormsley SB, Peter JB. Cytokines and immune regulation in patients with fibrositis. Arthritis Rheum. 1989;32:1334–5.CrossRefPubMed
21.
go back to reference Wilson RB, Gluck OS, Tesser JR, Rice JC, Meyer A, Bridges AJ. Antipolymer antibody reactivity in a subset of patients with fibromyalgia correlates with severity. J Rheumatol. 1999;26:402–7.PubMed Wilson RB, Gluck OS, Tesser JR, Rice JC, Meyer A, Bridges AJ. Antipolymer antibody reactivity in a subset of patients with fibromyalgia correlates with severity. J Rheumatol. 1999;26:402–7.PubMed
22.
go back to reference Shanklin DR, Stevens MV, Hall MF, Smalley DL. Environmental immunogens and T-cell-mediated responses in fibromyalgia: evidence for immune dysregulation and determinants of granuloma formation. Exp Mol Pathol. 2000;69:102–18.CrossRefPubMed Shanklin DR, Stevens MV, Hall MF, Smalley DL. Environmental immunogens and T-cell-mediated responses in fibromyalgia: evidence for immune dysregulation and determinants of granuloma formation. Exp Mol Pathol. 2000;69:102–18.CrossRefPubMed
23.
go back to reference Macedo JA, Hesse J, Turner JD, Ammerlaan W, Giesens A, Hellhamer DH, et al. Adhesion molecules and cytokine expression in fibromyalgia patients: increased L-selectin on monocytes and neutrophils. J Neuroimmunol. 2007;188:159–66.CrossRefPubMed Macedo JA, Hesse J, Turner JD, Ammerlaan W, Giesens A, Hellhamer DH, et al. Adhesion molecules and cytokine expression in fibromyalgia patients: increased L-selectin on monocytes and neutrophils. J Neuroimmunol. 2007;188:159–66.CrossRefPubMed
24.
go back to reference Burda CD, Cox FR, Osborne P. Histocompatibility antigens in the fibrositis (fibromyalgia) syndrome. Clin Exp Rheumatol. 1986;4:355–8.PubMed Burda CD, Cox FR, Osborne P. Histocompatibility antigens in the fibrositis (fibromyalgia) syndrome. Clin Exp Rheumatol. 1986;4:355–8.PubMed
25.••
go back to reference Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Guiliano T, De Feo F, et al. Cytokine patterns in fibromyalgia and their correlations with clinical manifestations. Clin Exp Rheumatol. 2007;25:225–30. This comprehensive study surveys multiple inflammatory markers in FM and suggests their elevation is more than coincidental.PubMed Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Guiliano T, De Feo F, et al. Cytokine patterns in fibromyalgia and their correlations with clinical manifestations. Clin Exp Rheumatol. 2007;25:225–30. This comprehensive study surveys multiple inflammatory markers in FM and suggests their elevation is more than coincidental.PubMed
26.
go back to reference Wallace DJ, Margolin K, Waller P. Fibromyalgia and interleukin-2 therapy for malignancy. Ann Intern Med. 1988;108:909.CrossRefPubMed Wallace DJ, Margolin K, Waller P. Fibromyalgia and interleukin-2 therapy for malignancy. Ann Intern Med. 1988;108:909.CrossRefPubMed
27.••
go back to reference Uceyler N, Kafke W, Riediger N, He L, Necula G, Toyka KV, et al. Elevated proinflammatory cytokine expression in affected skin in small fiber neuropathy. Neurology. 2010;74:1806–13. Subjects with length dependent SFN had significantly higher cytokine gene expression in affected skin, suggesting a role in pain production.CrossRefPubMed Uceyler N, Kafke W, Riediger N, He L, Necula G, Toyka KV, et al. Elevated proinflammatory cytokine expression in affected skin in small fiber neuropathy. Neurology. 2010;74:1806–13. Subjects with length dependent SFN had significantly higher cytokine gene expression in affected skin, suggesting a role in pain production.CrossRefPubMed
28.•
go back to reference Parambil JG, Tavee JO, Zhou L, Pearson KS, Culver DA. Efficacy of intravenous immunoglobulin for small fiber neuropathy associated with sarcoidosis. Respir Med. 2011;105(1):101–5. This paper suggests that SFN may be successfully treated with IVIg.CrossRefPubMed Parambil JG, Tavee JO, Zhou L, Pearson KS, Culver DA. Efficacy of intravenous immunoglobulin for small fiber neuropathy associated with sarcoidosis. Respir Med. 2011;105(1):101–5. This paper suggests that SFN may be successfully treated with IVIg.CrossRefPubMed
29.
go back to reference Sheikh KA, Zhang G, Gong Y, Schnaar RL, Griffin JW. An anti-ganglioside antibody-secreting hybridoma induces neuropathy in mice. Ann Neurol. 2004;56(2):228–39.CrossRefPubMed Sheikh KA, Zhang G, Gong Y, Schnaar RL, Griffin JW. An anti-ganglioside antibody-secreting hybridoma induces neuropathy in mice. Ann Neurol. 2004;56(2):228–39.CrossRefPubMed
30.•
go back to reference Grant IA. Cryptogenic sensory polyneuropathy. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. Philadelphia: Elsevier; 2005. p. 2321–33. Excellent general review of SFN.CrossRef Grant IA. Cryptogenic sensory polyneuropathy. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. Philadelphia: Elsevier; 2005. p. 2321–33. Excellent general review of SFN.CrossRef
31.
32.•
go back to reference Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep. 2002;6(4):259–66. A comprehensive discussion of the potential role of undiagnosed peripheral pain generators, feeding central sensitization, in FM.CrossRefPubMed Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep. 2002;6(4):259–66. A comprehensive discussion of the potential role of undiagnosed peripheral pain generators, feeding central sensitization, in FM.CrossRefPubMed
33.
go back to reference Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis Rheum. 2006;54(1):169–76.CrossRefPubMed Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis Rheum. 2006;54(1):169–76.CrossRefPubMed
34.
go back to reference Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160–72.CrossRefPubMed Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160–72.CrossRefPubMed
35.
go back to reference Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600–10.CrossRef Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600–10.CrossRef
36.•
go back to reference Tavee J, Zhou L. Small fiber neuropathy: a burning problem. Cleve Clin J Med. 2009;76(5):297–305. A very readable review of SFN; excellent for the clinician.CrossRefPubMed Tavee J, Zhou L. Small fiber neuropathy: a burning problem. Cleve Clin J Med. 2009;76(5):297–305. A very readable review of SFN; excellent for the clinician.CrossRefPubMed
37.•
go back to reference Caro XJ. Fibromyalgia: evaluation and therapy of a neuroimmune disorder. In: Mahmoudi M, editor. Challenging cases in rheumatology and diseases of the immune system. New York: Springer; 2013. p. 257–84. The author shows how to use ENFD (skin biopsy) in the evaluation of FM. Case examples are presented.CrossRef Caro XJ. Fibromyalgia: evaluation and therapy of a neuroimmune disorder. In: Mahmoudi M, editor. Challenging cases in rheumatology and diseases of the immune system. New York: Springer; 2013. p. 257–84. The author shows how to use ENFD (skin biopsy) in the evaluation of FM. Case examples are presented.CrossRef
38.
go back to reference Melzack R, Katz J. Pain assessment in adult patients. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 5th ed. Philadelphia: Elsevier; 2005. p. 291–304. Melzack R, Katz J. Pain assessment in adult patients. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 5th ed. Philadelphia: Elsevier; 2005. p. 291–304.
39.
go back to reference Martinez-Lavin M, Lopez S, Medina M, Nava A. Use of the Leeds assessment of neuropathic symptoms and signs questionnaire in patients with fibromyalgia. Semin Arthritis Rheum. 2003;32:407–11.CrossRefPubMed Martinez-Lavin M, Lopez S, Medina M, Nava A. Use of the Leeds assessment of neuropathic symptoms and signs questionnaire in patients with fibromyalgia. Semin Arthritis Rheum. 2003;32:407–11.CrossRefPubMed
40.
go back to reference Simms RW, Goldenberg DL. Symptoms mimicking neurologic disorders in fibromyalgia syndrome. J Rheumatol. 1988;15:1271–3.PubMed Simms RW, Goldenberg DL. Symptoms mimicking neurologic disorders in fibromyalgia syndrome. J Rheumatol. 1988;15:1271–3.PubMed
41.
go back to reference Katirji B. Clinical assessment in neuromuscular disorders. In: Katirji B, Kaminski HJ, Preston DC, Ruff RL, Shapiro BE, editors. Neuromuscular disorders. Boston: Butterworth Heinemann; 2002. p. 3–19. Katirji B. Clinical assessment in neuromuscular disorders. In: Katirji B, Kaminski HJ, Preston DC, Ruff RL, Shapiro BE, editors. Neuromuscular disorders. Boston: Butterworth Heinemann; 2002. p. 3–19.
42.
go back to reference DeJong RN. The neurologic examination: incorporating the fundamentals of neuroanatomy and neurophysiology. 4th ed. Cambridge: Harper & Row; 1979. p. 44–9. 67–8. DeJong RN. The neurologic examination: incorporating the fundamentals of neuroanatomy and neurophysiology. 4th ed. Cambridge: Harper & Row; 1979. p. 44–9. 67–8.
43.••
go back to reference Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. 2008;131:1912–25. Excellent study of the pathophysiology of SFN and how its neuropathology translates into clinical findings.PubMedCentralCrossRefPubMed Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. 2008;131:1912–25. Excellent study of the pathophysiology of SFN and how its neuropathology translates into clinical findings.PubMedCentralCrossRefPubMed
44.
go back to reference Ersoz M. Nerve conduction tests in patients with fibromyalgia: comparison with normal controls. Rheumatol Int. 2003;23:166–70.CrossRefPubMed Ersoz M. Nerve conduction tests in patients with fibromyalgia: comparison with normal controls. Rheumatol Int. 2003;23:166–70.CrossRefPubMed
45.
go back to reference Caro XJ, Winter E. Nerve conduction tests in patients with fibromyalgia syndrome. Rheumatol Int. 2005;25(1):77–8.CrossRefPubMed Caro XJ, Winter E. Nerve conduction tests in patients with fibromyalgia syndrome. Rheumatol Int. 2005;25(1):77–8.CrossRefPubMed
46.
go back to reference Ersoz M. Nerve conduction tests in patients with fibromyalgia: comparison with normal controls. Rheumatol Int. 2005;25(1):79–80.CrossRef Ersoz M. Nerve conduction tests in patients with fibromyalgia: comparison with normal controls. Rheumatol Int. 2005;25(1):79–80.CrossRef
48.
go back to reference Hays AP. Utility of skin biopsy to evaluate peripheral neuropathy. Curr Neurol Neurosci Rep. 2010;10:101–7.CrossRefPubMed Hays AP. Utility of skin biopsy to evaluate peripheral neuropathy. Curr Neurol Neurosci Rep. 2010;10:101–7.CrossRefPubMed
49.
go back to reference Kennedy WR, Wendelschafer-Crabb G, Polydefkis M, McArthur JC. Chapter 34: pathology and quantitation of cutaneous innervation. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 869–95.CrossRef Kennedy WR, Wendelschafer-Crabb G, Polydefkis M, McArthur JC. Chapter 34: pathology and quantitation of cutaneous innervation. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 869–95.CrossRef
50.
go back to reference Polydefkis M, Griffin JW, McArthur J. New insights into diabetic polyneuropathy. JAMA. 2003;290(10):1371–6.CrossRefPubMed Polydefkis M, Griffin JW, McArthur J. New insights into diabetic polyneuropathy. JAMA. 2003;290(10):1371–6.CrossRefPubMed
52.•
go back to reference Scadding JW, Koltzenburg M. Painful peripheral neuropathies. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2013. p. 926–51. A comprehensive review of peripheral neuropathic pain mechanisms. Scadding JW, Koltzenburg M. Painful peripheral neuropathies. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2013. p. 926–51. A comprehensive review of peripheral neuropathic pain mechanisms.
53.
go back to reference Dyck PJ, Lambert EH, O’Brien PC. Pain in peripheral neuropathy related to rate and kind of fiber degeneration. Neurology. 1976;26:466–71.CrossRefPubMed Dyck PJ, Lambert EH, O’Brien PC. Pain in peripheral neuropathy related to rate and kind of fiber degeneration. Neurology. 1976;26:466–71.CrossRefPubMed
54.
go back to reference Gilron I, Baron R, Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin Proc. 2015;90(4):532–45.CrossRefPubMed Gilron I, Baron R, Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin Proc. 2015;90(4):532–45.CrossRefPubMed
55.
go back to reference Davis-Richardson AG, Triplett EW. A model for the role of gut bacteria in the development of autoimmunity for type 1 diabetes. Diabetologia. 2015;58(7):1386–93.PubMedCentralCrossRefPubMed Davis-Richardson AG, Triplett EW. A model for the role of gut bacteria in the development of autoimmunity for type 1 diabetes. Diabetologia. 2015;58(7):1386–93.PubMedCentralCrossRefPubMed
56.
go back to reference Gomez A, Luckey D, Taneja V. The gut microbiome in autoimmunity: sex matters. Clin Immunol. 2015;6:S1521–6616. Gomez A, Luckey D, Taneja V. The gut microbiome in autoimmunity: sex matters. Clin Immunol. 2015;6:S1521–6616.
57.
go back to reference Rogier R, Koenders MI, Abdollahi-Roodsaz S. Toll-like receptor mediated modulation of T cell response by commensal intestinal microbiota as a trigger for autoimmune arthritis. J Immunol Res. 2015;2015:527696.PubMedCentralCrossRefPubMed Rogier R, Koenders MI, Abdollahi-Roodsaz S. Toll-like receptor mediated modulation of T cell response by commensal intestinal microbiota as a trigger for autoimmune arthritis. J Immunol Res. 2015;2015:527696.PubMedCentralCrossRefPubMed
58.
go back to reference Van Praet JT, Donovan E, Vanassche I, Drennan MB, Windels F, Dendooven A, et al. Commensal microbiota influence systemic autoimmune responses. EMBO J. 2015;34(4):466–74.CrossRefPubMed Van Praet JT, Donovan E, Vanassche I, Drennan MB, Windels F, Dendooven A, et al. Commensal microbiota influence systemic autoimmune responses. EMBO J. 2015;34(4):466–74.CrossRefPubMed
Metadata
Title
The Role and Importance of Small Fiber Neuropathy in Fibromyalgia Pain
Authors
Xavier J. Caro
Earl F. Winter
Publication date
01-12-2015
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 12/2015
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-015-0527-7