Fibromyalgia syndrome pathology and environmental influences on afflictions with medically unexplained symptoms.
Albrecht, Phillip J, Rice, Frank L · Reviews on environmental health · 2016 · DOI
Quick Summary
This review examines fibromyalgia syndrome (FMS) as a model for understanding conditions with symptoms that are difficult to explain medically. The authors discuss how nerve endings in the skin and stress hormones (particularly estrogen) may play a role in causing widespread pain and fatigue. They propose that environmental stress and past trauma can trigger changes in how the nervous system works, leading to increased pain sensitivity.
Why It Matters
This work is significant because it proposes a plausible peripheral mechanism (altered skin innervation) that could explain widespread pain in conditions like ME/CFS and FMS, moving beyond purely psychological explanations. Understanding shared pathophysiological features across MUS conditions may accelerate identification of objective biomarkers and targeted treatments applicable to ME/CFS populations.
Observed Findings
Increased peptidergic sensory innervation associated with arterio-venous shunts in glabrous hand skin of FMS patients
Alterations in neurotransmitter and enzyme levels in FMS
Immune and cytokine functionality changes documented in FMS
Reduced cortical volumes identified in FMS patients
Reduced cutaneous innervation density in some FMS cohorts
Inferred Conclusions
Peripheral innervation alterations may provide a plausible mechanism explaining widespread FMS symptomatology
Environmental stressors and trauma history influence FMS development through autonomic and endocrine pathways
Estrogen-related mechanisms may contribute to the female predominance of FMS and related MUS conditions
FMS serves as a useful model for understanding central sensitization syndromes across multiple MUS conditions
Remaining Questions
Do altered skin nerve endings cause central sensitization, or are they a consequence of it?
What is the specific role of estrogen in driving peripheral innervation changes and pain amplification?
What This Study Does Not Prove
This is a review article that does not present original experimental or clinical data, so it cannot prove causation or establish the prevalence of proposed mechanisms. It does not definitively establish that skin innervation changes cause FMS symptoms, only that they may be associated with them. The role of estrogen in ME/CFS pathology remains speculative and requires prospective research.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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