) Evidentemente, me dió el alta porque "como ya te llevan otros neurólogos (de pago) no hace falta que vuelvas". Es lo que tiene la ciencia... que, con el tiempo, da la razón a quien la tiene
En cuanto al estudio, aunque la muestra es pequeña, compara pacientes con Fibromialgia (25) con pacientes con Depresión (10) y Controles Sanos. Todos ellos sin neuropatía de fibra gruesa y exploraciones neurológicas y neurofisiológicas normales. El estudio investiga la función y morfología de los nervios de fibra fina en estos pacientes mediante tres métodos diferentes y llega a la conclusión de que los resultados en los tres métodos reafirman el concepto de que hay un problema de la función de la fibra fina, lo que implica que el dolor en la fibromialgia es de tipo neuropático.
[t]Small fibre pathology in patients with fibromyalgia syndrome[/t]
Brain. 2013 Jun;136(Pt 6):1857-67. doi: 10.1093/brain/awt053. Epub 2013 Mar 9.
Üçeyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, Casanova-Molla J, Reiners K, Sommer C.SourceDepartment of Neurology, University of Würzburg, 97080 Würzburg, Germany. [email protected]
Abstract
Fibromyalgia syndrome is a clinically well-characterized chronic pain condition of high socio-economic impact. Although the pathophysiology is still unclear, there is increasing evidence for nervous system dysfunction in patients with fibromyalgia syndrome.
In this case-control study we investigated function and morphology of small nerve fibres in 25 patients with fibromyalgia syndrome. Patients underwent comprehensive neurological and neurophysiological assessment. We examined small fibre function by quantitative sensory testing and pain-related evoked potentials, and quantified intraepidermal nerve fibre density and regenerating intraepidermal nerve fibres in skin punch biopsies of the lower leg and upper thigh.
The results were compared with data from 10 patients with monopolar depression without pain and with healthy control subjects matched for age and gender. Neurological and standard neurophysiological examination was normal in all patients, excluding large fibre polyneuropathy.
Patients with fibromyalgia syndrome had increased scores in neuropathic pain questionnaires compared with patients with depression and with control subjects (P < 0.001 each). Compared with control subjects, patients with fibromyalgia syndrome but not patients with depression had impaired small fibre function with increased cold and warm detection thresholds in quantitative sensory testing (P < 0.001).
Investigation of pain-related evoked potentials revealed increased N1 latencies upon stimulation at the feet (P < 0.001) and reduced amplitudes of pain-related evoked potentials upon stimulation of face, hands and feet (P < 0.001) in patients with fibromyalgia syndrome compared to patients with depression and to control subjects, indicating abnormalities of small fibres or their central afferents.
In skin biopsies total (P < 0.001) and regenerating intraepidermal nerve fibres (P < 0.01) at the lower leg and upper thigh were reduced in patients with fibromyalgia syndrome compared with control subjects. Accordingly, a reduction in dermal unmyelinated nerve fibre bundles was found in skin samples of patients with fibromyalgia syndrome compared with patients with depression and with healthy control subjects, whereas myelinated nerve fibres were spared.
All three methods used support the concept of impaired small fibre function in patients with fibromyalgia syndrome, pointing towards a neuropathic nature of pain in fibromyalgia syndrome.
