Small Fiber Neuropathy in Ehlers-Danlos Patients
By: Brian Kitzerow PT, DPT, OCS, CMPT
Problems with pain management is often the primary complaint in patients suffering from Ehlers-Danlos Syndrome (EDS). Much of this pain is of a musculoskeletal nature such as a sprains, tendinosis or joint subluxation. But often our patient’s pain complaints are of a less clear nature. This pain can be described as a burning or stabbing sensation that moves throughout the body inexplicably and without identifiable causes. Recent research by Cazzato, et al. has demonstrated that patients with EDS have a very high chance of manifesting small fiber neuropathy in the sensory fibers of their skin.
Neuropathy is the inflammation or death of nerve fibers in the outer-layers of our bodies. This is commonly seen in diabetic patients as a result of changes in their blood chemistry. However it has recently been identified that more than 90% of investigated EDS patients demonstrate evidence of localized small fiber neuropathy. This has commonly been identified and treated in the fibromyalgia populations with medications such as Neurontin/Gabapentin, Amitriptyline, Pregabalin and Cymbalta.
This type of pain would be classified as neuropathic pain and is very different from mechanical type musculoskeletal pain. Pain medications like NSAID, opioids and muscle relaxants that are prescribed for musculoskeletal pain are often unsuccessful for treating neuropathically induced pains.
The Cazzato study reported 19 of 24 EDS patients complained of moderate to severe symptoms consistent with neuropathic pain. When their research patients were examined via skin biopsy all 24 demonstrated findings consistent with small fiber neuropathy.
When discussing pain medication with your providers it is important to identify what the underlying pain generators are in order to pick efficacious medicines. If your pain is a diffuse burning discomfort that bounces around the surface levels of skin, fascia and muscles you may benefit from a medication specifically targeting neurogenic pain.
Reference
Small Fiber neuropathy is a common feature of Ehlers-Danlos syndrome. Cazzato D, Castori M, Lombardi R, Caravello F, Bella ED, Petrucci A, Grammatico P, Dordoni C, Colombi M, Lauria G. Neurology. 2016 Jul 12;87(2):155-9
Small-Fiber Neuropathy: Answering the Burning Questions. Fink E, Oaklander A. Science of Aging Knowledge Environment. 2006; 6
Pain in Ehlers-Danlos syndromes: manifestations, therapeutic strategies and future perspectives. Castori, M. Expert Opinion on Orphan Drugs, 2016 VOL. 4, NO. 11, 1145–1158
New Additions to Good Health
2016 was a very busy and exciting year at Good Health. We now have eight physical therapist on staff to meet all your physical therapy needs. Our latest additions are Chie Tadaki, PT, DPT and Sara Avni, PT, DPT. Chie and Sara help round out our existing roster of talented therapists
