Fibromyalgia isn’t all in your head…It’s in your hands.

Wait. What?

A breakthrough study has found a clear tissue differentiation in the hands of women with fibromyalgia. Researchers took biopsies of palms and found an increased concentration of a type of nerve fibre that regulates blood flow through specialized shunts, found only in hands and feet (Fig. 1). **

This study is important because it provides a biological test that physicians in the future will be able to use to diagnose fibromyalgia, rather than relying on subjective measures. It also firmly proves all the skeptics and naysayers wrong. Secondly, the research points to an explanation for what causes fibromyalgia.

So, what causes it? We need to start with a short biology lesson to understand. Arteries carry oxygenated blood to our tissues, moving from large artery vessels to smaller arterioles and finally to capillaries. Capillaries supply the local tissue with oxygenated blood and collect de-oxygenated blood which they carry to veins (via small vessels called venules). In the hands and feet there are specialized shunts (think valves), which can redirect blood flow towards or away from the capillary beds in the palms and soles. As Dr. Frank Rice, the leading scientist at Integrated Tissue Dynamics LLC (Intidyn), as part of a fibromyalgia study based at Albany Medical College, explains, “The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature…Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, and our hands get sweaty. Under cold conditions, the shunts open wide allowing blood to bypass the capillaries in order to conserve heat, and our hands get cold.” * The shunts are controlled by nerve fibres that open and close as needed. Fibromyalgia patients have an increased concentration of the nerve fibres which open the shunts. This picture does a better job of explaining how it works:

So what does this mean? It turns out that the hands and feet act like a reservoir for blood. When blood is needed by other tissues in the body, such as active muscles, it can be diverted where it’s needed. If the blood flow is mismanaged because of the distinct tissue pathology found in the fibromyalgia patients, it could cause the muscle pain and achiness which characterizes the disease.* Furthermore, the researchers believe mismanaged blood flow could cause fibro fog and sleep problems. Dr. Rice says this research “appear[s] to fit with other published evidence demonstrating blood flow alterations to higher brain centers and the cerebral cortex of fibromyalgia patients”.*

This research really shakes up the conventional explanations for what causes fibromyalgia. It’s exciting, but I’m not quite sure what to make of it. How does it fit with recent research demonstrating immune dysfunction at the cellular level in FM patients? Or previous studies which have found altered levels of neurotransmitters like serotonin, dopamine, and substance P?

Personally, I don’t experience extreme sensitivity in my hands and feet, which Dr. Rice suggests is common for FM patients. I do find the sensation of cold objects painful when they shouldn’t be. In addition, my hands and feet are always icy cold. I’ve caused quite a few shocked yelps from my husband when my feet inadvertently touch his, or when I try to hold his hand!

Overall this is an exciting step towards finding the cause of FM and it will be interesting to see where it leads.

References:

Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL (2013). 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 Medicine, May 20. doi: 10.1111/pme.12139 [Epub ahead of print].

Posted at the National Library of Medicine (PubMed): http://www.ncbi.nlm.nih.gov/pubmed/23691965

A description of this study for the general public can be found at: http://www.intidyn.com/Newsroom/Fibromyalgia Pathology for lay people 2013-06-24.pdf