Fibromyalgia and thin fiber neuropathy: When the nerves crackle

Last updated 15/02/2024 by The pain clinics - Interdisciplinary Health

Fibromyalgia and thin fiber neuropathy: When the nerves crackle

Research points to a relationship between fibromyalgia and thin fiber neuropathy. Here you will learn more about the connection and what this entails.

Fibromyalgia is a very complex, chronic pain syndrome. There is no doubt about that. Among other things, we know that the condition can give rise to a wide range of different types of pain and symptoms. This also includes possible symptoms such as widespread pain, fatigue, brain fog, TMD syndrome, irritable bowel syndrome and hyperalgesia (increased pain reporting). More recently, it has been understood that the pain syndrome includes both rheumatic and neurological components.

- What is thin fiber neuropathy?

(Figure 1: Overview of the skin layers)

To understand thin fiber neuropathy, we must first start with an overview of the layers of the skin (see Figure 1 above). The outermost layer is called the epidermis, also called the epidermis, and it is here that we find what we call intraepidermal nerve fibres. That is, nerve fibers and nerve cells inside the epidermis.

– Malfunctions and defects

Thin fiber neuropathy refers to the loss of – or malfunction of – thin intraepidermal nerve fibers. This thin fiber neuropathy can give rise to a wide range of symptoms - which we think many people with fibromyalgia will probably recognize. A major research study published in 2015 has shown that many people with fibromyalgia have just such nerve findings in the epidermis.¹ Let's take a closer look at the symptoms and clinical signs in the next part of the article.

Our clinic departments at Vondtklinikkene (click here  for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want the help of therapists with expertise in these fields.

7 symptoms and clinical signs of thin fiber neuropathy

Here we will first present a list of seven known symptoms and clinical signs.² Next, we'll take a closer look, in detail, at what they actually mean. Fibromyalgia patients will be quite familiar with many of them. Studies have shown how symptoms of thin fiber neuropathy can overlap with several known fibromyalgia symptoms.³

1. Higher pain intensity (hyperalgesia)

2. Stinging, stabbing pains

3. Paresthesia

4. Allodynia

5. Dry eyes and dry mouth

6. Changed sweating pattern

7. Heat hypoesthesia and cold hypoesthesia

1. Higher pain intensity (hyperalgesia)

Let's break that word down a bit. Hyper means more. Algesia means the ability to feel pain. Hyperalgesia thus refers to feeling more pain than usual - which in turn means that the pain receptors are overactive and fire more than they should. In short, this results in increased pain tension and pain signals. A familiar symptom for many with fibromyalgia. This is also part of the basis for why relaxation (for example on acupressure mat or with neck hammock) and self-measures are so important for people with chronic pain.

- Read more about acupressure mat via the image below:

2. Stinging, stabbing pains

Perhaps you have experienced it yourself? These sudden stabbing and stabbing pains that feel different? This type of pain is often related to nerves and nerve signals. The reason why one experiences the pain in this way can again be linked back to symptom #1 and symptom #4 in this list.

Good tip: Biofrost (natural pain relief)

For those who suffer a lot from pain, it may be useful to try natural pain ointments - such as Biofrost or arnica gel. The gel works in such a way that it desensitizes the pain fibres, and thus causes them to send less pain signals. This is, of course, particularly relevant for people who have chronic pain in soft tissue and joints. Press the image or here to read more about how it works.

3. Paresthesia

Paresthesias come in many formats. The symptom means that one feels signals on or in the skin without external influence or that there is a basis for it. This may include, among other things:

• Tingling (as if ants are walking on the skin)

• Numbness

• Burning

• Stitching

• tingling

• Itching

• Heat or cold sensation

It is therefore believed that these sensory error signals may originate from malfunctions in intraepidermal nerve fibres.

4. Allodynia

When stimuli, such as a very light touch, give you pain - this is called allodynia. This is due, among other things, to significant misreporting in the central nervous system, within the areas that are supposed to interpret both touch and pain. It is also known as central pain sensitization.

- Pain clinics: We can help you with pain in muscles and joints

Our publicly authorized clinicians at our affiliated clinics The pain clinics has a distinctive professional interest and expertise in the investigation, treatment and rehabilitation of muscle, tendon, nerve and joint ailments. We work purposefully to help you find the cause of your pain and symptoms - and then help you get rid of them.

See clinic overview

5. Dry eyes and dry mouth

Several types of rheumatism and autoimmune diseases cause disturbances in the gland functions - which leads to the production of less tears and saliva. For this reason, many may also experience problems with dry eyes and dry mouth.

Sleep tips: Preserve eye moisture with a specially designed sleeping mask

Daily the sleep mask is specially designed so as not to put pressure or irritate the eyes. Precisely for this reason, it has a design that gives the eyes better space and comfort, but which still preserves the light density. In this way, it is also easier to preserve the moisture in the eyes at night. Considering how important good sleep is, this is a good investment for the vast majority of us. Press here to read more about it.

6. Changed sweating pattern

Have you noticed that you sweat more in some areas? Then maybe notice that you don't sweat in certain areas? Thin fiber neuropathy can lead to altered sweating patterns - and can also contribute to disturbances in sweat formation.

7. Heat hypoesthesia and cold hypoesthesia

Hypoaesthesia means that one has a complete or partial loss of sensory sensation in an area of ​​the body. This could be, for example, on the outside of the calf - or on the inside of the elbow. In fact, it can occur anywhere, and many people are therefore unaware that they have areas that do not respond to stimuli from heat or cold. What is quite strange is that such an area, which may not feel cold stimuli, can feel heat in a completely normal way - or vice versa.

Research: Changes in the nerve fibers in the epidermis in people with fibromyalgia

Let's go back to the study we mentioned earlier in the article.¹ Here, the researchers used special equipment, including a bio-microscope, to take skin biopsies from fibromyalgia patients - and then compared them with skin biopsies from people without fibromyalgia. Here they concluded, among other things, that the people with fibromyalgia had a smaller number of epidermal nerve fibers - which gives a strong indication that fibromyalgia is also, as indicated via other studies, a neurological diagnosis (in addition to rheumatological).

– 5 categories of fibromyalgia?

Here we want to focus on an article that was recently published by Eidsvoll Sundet Chiropractic Center and Physiotherapy. This was titled '5 categories of fibromyalgia' (the link opens in a new browser window - so you can read it afterwards). Here they referred to a recent study which believed that fibromyalgia had five categories - including a category called neuropathic fibromyalgia. Considering that not all people with fibromyalgia have signs of thin fiber neuropathy. so one can perhaps speculate that patients in the (possible) category have a higher incidence of such clinical symptoms?

"Summary: This is incredibly exciting research! And we hope that such deep dives can also contribute to uncovering the mysteries surrounding fibromyalgia in the future. In this way, it is possible to facilitate new treatment methods.

We end the article with an apt quote from Naomi Wolf:

"Pain is real when other people believe it hurts. If no one but you believes it, your pain is madness or hysteria.”

The quote explains quite well how many people with fibromyalgia must feel when they are not believed or heard.

Join our fibromyalgia support group

Feel free to join the Facebook group «Rheumatism and Chronic Pain - Norway: Research and news» (Press here) for the latest updates on research and media writing about rheumatic and chronic disorders. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice. Otherwise, we would greatly appreciate it if you would follow us on our Facebook page and YouTube channel.

Please share to support those with invisible illness

Hello! Can we ask you a favor? We kindly ask you to like the post on our FB page and to share this article on social media or via your blog (please link directly to the article). We are also happy to exchange links with relevant websites (contact us on Facebook if you want to exchange links with your website). Understanding, general knowledge and increased focus are the first step towards a better everyday life for those with chronic pain diagnoses. So we hope that you will help us with this knowledge battle!

The pain clinics: Your choice for modern interdisciplinary health

Our clinicians and clinic departments always aim to be among the top elite in the field of investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Viken (Raw wood og Eidsvoll Sound).

See clinic overview

Sources and research

1. Ramirez et al, 2015. Small fiber neuropathy in women with fibromyalgia. An in vivo assessment using corneal confocal bio-microscopy. Semin Arthritis Rheum. 2015 Oct;45(2):214-9. [PubMed]

2. Oaklander et al, 2013. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013 Nov;154(11):2310-2316.

3. Bailly et al, 2021. The challenge of differentiating fibromyalgia from small-fiber neuropathy in clinical practice. Joint Bone Spine. 2021 Dec;88(6):105232.

Article: Fibromyalgia and thin fiber neuropathy – when the nerves crackle

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

FAQ: Frequently asked questions about fibromyalgia and thin fiber neuropathy?

1. How can neuropathic pain be alleviated?

There is evidence that a holistic approach is important. Then we talk, among other things, about circulation exercises for legs and arms, relaxation techniques, nerve mobilization exercises (stretches and stimulates the nervous tissue), adapted physical treatment and musculoskeletal laser therapy (the link opens in a new window).