Clinical Rheumatology

, Volume 37, Issue 12, pp 3167–3171 | Cite as

Fibromyalgia and small fiber neuropathy: the plot thickens!

  • Manuel Martínez-Lavín
Review Article


Several groups of investigators have described the presence of small fiber neuropathy in fibromyalgia patients. This writing discusses how this new finding could renovate fibromyalgia concept, diagnosis, and treatment. Predominant rheumatology thinking proposes fibromyalgia as a “centralized pain syndrome.” An alternative hypothesis views fibromyalgia as a stress-related dysautonomia with neuropathic pain features. Dorsal root ganglia may be the key autonomic-nociceptive short-circuit sites. The recent recognition of small fiber neuropathy in a large subgroup of fibromyalgia patients reinforces the dysautonomia-neuropathic hypothesis and validates fibromyalgia pain. These new findings support fibromyalgia as a primarily neurological entity, nevertheless, rheumatologist will likely remain the best equipped specialist to diagnose fibromyalgia and differentiate it from other multi-symptomatic rheumatic syndromes. Skin biopsy and corneal confocal microscopy will probably become useful fibromyalgia diagnostic tests. Dorsal root ganglia sodium channel blockers are potential fibromyalgia analgesic medications. Subgroups of young girls with “autoimmune neuropathic fibromyalgia” may respond to immunoglobulin therapy. Multimodal intervention directed to regain autonomic nervous system resilience will likely remain the cornerstone for fibromyalgia therapy.


Dorsal root ganglia Dysautonomia Fibromyalgia HPV vaccine Postural orthostatic tachycardia syndrome Small fiber neuropathy Sodium channels Sympathetic pain 


Compliance with ethical standards




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Rheumatology DepartmentNational Institute of CardiologyMexico CityMexico

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