Dr. Frank Rice remembers the day when he realized he was onto something.
“There was something very unusual that we had just never seen before,” Rice recalls. “It’s one of those things that get you jumping up from the microscope and running down the halls, grabbing people and saying ‘Here, come take a look at this!’”
What Rice was looking at under his microscope was skin biopsy tissue, less than half the size of a pencil eraser, taken from the palms of female fibromyalgia patients. In 17 of the 18 samples that could be analyzed, Rice says the patients had an unusual amount of extra nerve fibers that had somehow “sprouted” around tiny blood vessels in their skin.
Finding the same disorder in 17 out of 18 patients was significant – even for a small study.
“That was what was so striking about this. It was so drastically different from anything we have seen before,” says Rice, who is president and chief scientist of Integrated Tissue Dynamics LLC (Intidyn), a bioresearch company based in Rensselaer, New York.
“It was a really, really striking pathology.”
What Rice and his colleagues at Intidyn and Albany Medical College may have discovered is the first biological evidence of what causes the pain and other symptoms of fibromyalgia, a complex disorder that has stumped physicians and researchers for decades.
Fibromyalgia patients typically suffer from joint pain, deep tissue pain, fatigue, depression, headaches and lack of sleep. What causes this whole range of symptoms – which are difficult to treat, much less cure – has long been a mystery.
“We suspected there would be something to see. Yet this is such an ‘out of the box’ finding about fibromyalgia that it has the potential to change not only the way we look at the disorder but also the way we can treat it and more effectively take care of people who have it,” said Dr. Charles Argoff, an Albany Medical Center neurologist and pain specialist, who was the study’s chief investigator.
Argoff and Rice compare fibromyalgia to a car with a broken cooling system. When the engine first starts, the car runs smoothly. But eventually the engine overheats and the car breaks down.
What causes the body to “overheat” with fibromyalgia?
The culprit may be those excess nerve fibers, which accumulate around tiny muscular valves or “shunts” that have a unique structure in blood vessels on the palms of the hands, as well as the soles of the feet.
The shunts, which are about the size of a pencil point, act as thermostats that regulate body heat. Under warm conditions, the shunts close down to force blood into the capillaries of the skin – radiating heat away from the body. Under cold conditions, the shunts open wide, allowing blood to bypass the capillaries in order to conserve heat.
That may explain why fibromyalgia patients often have painful or tender hands, and are sensitive to sudden weather changes. The shunts could also be interfering with the flow of blood to muscles and organs throughout the body, which would account for the widespread pain, achiness and fatigue that occurs in fibromyalgia patients.
As we reported last week, Rice and Argoff have reported their findings in Pain Medicine, the journal of the American Academy of Pain Medicine. They are also broadening their research, to see if excess nerve fibers may play a role in other chronic pain disorders.