Tuesday, April 30, 2013

Fibromyalgia and a New Paradigm?



In the article “Small Nerve Fibers and Fibromyalgia: Five Signposts to a New Paradigm” Nurcan Üçeyler wants to convince us, that science should reverse its course and leave CNS studies and go back to peripheral nerves.

1. “The pathophysiology of pain in FMS is unknown.”
I don’t see that this is a signpost for peripheral nerve studies.

2. “Small fibers are abnormal in patients with FMS.”
That’s a statement! A study of N=25 doesn’t say much. “Patients were recruited from all over Germany”. How strange, as there is an abundance of people being afflicted with fibromyalgia. Why look all over Germany and handpick people for a study? Why test these 25 patients against depressive patients? Why not against patients suffering from chronic back pain? Another point that won’t pass as a signpost.

3. “FMS is different from depression.”
Another strange idea. Fibromyalgia is considered to be a chronic pain disorder and isn’t considered to be a form of depression. Let’s erase this signpost, too.

4. “FMS is a distinct syndrome involving neuropathic pain.”
Let’s call it an unproven hypothesis and not a signpost.

5. “FMS is different from small fiber neuropathy.”
I don’t see a signpost in this statement. It shows that it’s more than premature to talk about a change of paradigms.

The author thinks that future studies on small fibre damage could be the “basis for the design of specific analgesic drugs.” Drugs haven’t been a big success in fibromyalgia and won’t be as pain processing in the CNS is involved. Why should the development of a new drug against small fibre neuropathy be stimulated by these findings?

I don’t want to call someone off research as also dead ends allows conclusions, but don’t call a dead end a change of paradigms.

Link to the article of Nurcan Üçeyler: http://www.musculoskeletalnetwork.com/fibromyalgia/content/article/1145622/2139011

4 comments:

  1. Mea culpa. I am the mere editor who used the term "paradigm" in the headline.

    The author did not use the term. However, an objective measurement of pain in fibromyalgia is surely at least an advance, not a "dead end."

    In any case, thank you for pointing out the article.

    Lois Wingerson
    Editorial Director
    Rheumatology Network

    ReplyDelete
  2. Thanks for clarifying this.
    Where's the objective measurement of pain?

    ReplyDelete
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    ReplyDelete
    Replies
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      Delete