Last week I wrote about the Fibromyalgia Flotation Project and said “fibromyalgia is not well understood at all”. This week I found interesting new research, just published in June! Here’s a quick update.
For what I believe is the first time, a physiological mechanism for fibro symptoms has been found. This is important, and not just because it means that medications for the disease can now be contemplated. Fibromyalgia has been such a mysterious condition that many doctors have thought it might be entirely in the mind, or even faked. That at least should now be disproven, and a surprising new method of diagnosis is available.
The mechanism found was completely unexpected. Most descriptions of the disease have believed it to be a condition of the central nervous system, resulting in increased sensitivity to the pain. Researchers at Integrated Tissue Dynamics in Rensselaer, NY, however, have located the pathology in the blood vessels of the skin. 
Fibro sufferers have been found to have an enormous increase of nerve fiber attached to fine blood vessels in the palms. Specifically, these vessels are called “arteriole-venule shunts”, and are normally used by the body for temperature regulation. When the body is warm, the shunts are closed, pushing blood out through near-surface capillaries where heat can be radiated. When the body is cold, the shunts open, allowing blood flow to bypass the surface and conserve its heat.
A malfunction of this mechanism then can explain several major symptoms of fibromyalgia. The excess of nerves leads directly to pain sensitivity. They are intended to trigger in cold conditions, which are generally very uncomfortable for fibro patients. And further,
“In addition to involvement in temperature regulation, an enormous proportion of our blood flow normally goes to our hands and feet. Far more than is needed for their metabolism,” noted Dr. Rice. “As such, the hands and the feet act as a reservoir from which blood flow can be diverted to other tissues of the body, such as muscles when we begin to exercise. Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation in fibromyalgia patients. This, in turn, could contribute to the hyperactivity in the brain.”
That, admittedly, is four “could be“s and “thought to be“s in a row. We’re still a long way from a full understanding of the condition. It is quite possible, also, that there are other still-unknown contributing factors, and further, there’s no indication from this research why fibro should have the sudden onset triggered by trauma, as it often seems to be. But science advances one step at a time, and this still seems to be a big one.
The research team posted a more detailed plain-English explanation for patients, if you want more information.
 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
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