Abstract Details

Title A Peripheral Neurovascular Pathology Associated with Fibromyalgia Patients

Topic Ethics, Pain and Palliative Care

Presentation(s) S17 - (-)

Poster/Presentation
Number 006

Objective

Background Fibromyalgia is characterized by chronic widespread pain, severe fatigue, sleep disturbances, cognitive dysfunction and other co-morbidities. The pathophysiology of fibromyalgia is unknown. Current therapies are marginally effective. Fibromyalgia research has focused on mechanisms of central sensitization; however, there are indications that peripheral ischemia may be sensitizing afferents in deep tissues. Since serotonergic/noradrenergic reuptake inhibitors can provide therapeutic benefit, we hypothesized that a fibromyalgia pathology might involve convergence of dense sympathetic, C and A-delta sensory innervation on arterioles and arteriole-venule shunts located deep in the dermis. Previous studies demonstrate that noradrenergic sympathetic terminals mediate vasoconstriction, whereas sensory terminals contribute to vasodilation by releasing the vasodilatory and pro-inflammatory peptides, calcitonin gene-related peptide, and substance P. The sympathetic innervation can inhibit the sensory innervation through an alpha 2 receptor mechanism.

Design/Methods We used multi-molecular immunolabeling to evaluate the innervation in 3mm punch biopsies from glabrous palmar skin and upper thoracic back skin in 24 female fibromyalgia patients and 23 age-matched female control subjects.

Results The arteriole-venule shunts , which are only in the palmar skin, had excessive innervation in fibromyalgia patients consisting of abnormally high sensory to sympathetic proportions.

Conclusions This arteriole-venule pathology may contribute to the severe pain and tenderness in the hands of fibromyalgia patients. Since sensory-mediated dilatation of the arteriole-venule shunt diverts blood flow from capillaries to conserve heat, the excessive imbalance os sensory innervation may be related to aggrevated fibromyalgia symptoms under cold conditions. Such peripheral neurovascular patholgy in the glabrous skin of fibromyalgia patients may result in wide-ranging ischemic effects contributing to symptoms of diffuse deep pain and fatigue.

Authors/Disclosures
Phillip Albrecht (Albany Medical College) PRESENTER	No disclosure on file
	No disclosure on file
Charles E. Argoff, MD (Albany Medical Center)	Dr. Argoff has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nevro. Dr. Argoff has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for XGene. Dr. Argoff has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Vertex. Dr. Argoff has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Scilex. Dr. Argoff has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Colllegium. Dr. Argoff has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vertex. Dr. Argoff has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan/Abbvie. Dr. Argoff has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lundbeck. Dr. Argoff has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Scilex. Dr. Argoff has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Scilex. The institution of Dr. Argoff has received research support from Lilly. The institution of Dr. Argoff has received research support from Lundbeck. The institution of Dr. Argoff has received research support from Abbvie. The institution of Dr. Argoff has received research support from Vertex. Dr. Argoff has received publishing royalties from a publication relating to health care.
James R. Storey, MD, FAAN	No disclosure on file
James P. Wymer, MD, PhD, FAAN (Department of Neurology, University of Florida)	No disclosure on file
	No disclosure on file
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.

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