Category Archives: Fibromyalgia Small Fiber Neuropathy

Fibromyalgia Small Fiber Neuropathy

Dr. Martin Rutherford: Hi. Good to see you again. We are going to do kind of an interesting topic today. We’re doing it because there seems to be people that are on the web searching for it. It”s fibromyalgia and small fiber peripheral neuropathy.

This is kind of a new development in both of those fields. A new understanding is evolving relative to fibromyalgia which we might even discuss is a term that probably needs to be abandoned. You heard it here first. Indeed, it’s something that people are starting to look for on the web.

We, Dr. Gates and I, run a largely chronic pain practice of which fibromyalgia and peripheral neuropathy are a significant percentage of the people that we treat. I would say for years, we have noticed that fibromyalgia patients will come in. Your particular aspect of the exam, doing the nervous system, will almost more often than not produce the understanding that they have peripheral neuropathy also. I don’t know if we see it as much the opposite way around where somebody would come in with peripheral neuropathy and have fibromyalgia.

Dr. Randall Gates: Not as often.

Dr. Martin Rutherford: We see it, but nowhere near as often as that. We see it both ways. Now, one of Dr. Gates’ hobbies is to spend two or three hours a night researching everything in the world about what we do. I’m very grateful for that, because I don’t do that.

There is some new data that’s coming out there. It’s very interesting. It’s correlating with what we’re seeing, so we thought it would be interesting if Dr. Gates shared some of his findings with you and maybe even why I just stated that. We said for a long time fibromyalgia is a dumb term. It means you have pain in your muscle fibers, and it really isn’t even that.

Dr. Randall Gates: Not at all.

Dr. Martin Rutherford: It’s an even dumber term based on the fact that it doesn’t tell you anything about what’s wrong with you, but based on the fact that it isn’t really pain in your muscle fibers. I will turn this over to Dr. Gates at the moment, and he can show you some of the exciting new stuff that has been helping us to understand better what we’re doing and has helped us to go forward with maybe advancing our treatment in this area.

Dr. Randall Gates: Yeah. As you alluded to, the first understanding of fibromyalgia was that this person, or you out there watching, or a loved one, has severe pain throughout the entire body. We thought that the pain was in the muscles, because that’s where it felt as though the pain was.

Dr. Martin Rutherford: Right.

Dr. Randall Gates: Then, as time went on and studies evolved, we learned that there really was nothing wrong with the muscles. And instead, there were problems with the spinal cord and the brain and how the body was interpreting this pain. We really locked onto, I say we, the scientific community locked onto…

Dr. Martin Rutherford: Stress.

Dr. Randall Gates: …stress as a major provocative factor for triggering the spinal cord to not be able to shut off pain as well as inflammation throughout the system. We even quoted articles from earlier this year really sending the association between Hashimoto’s thyroiditis, which is an immune condition against the thyroid, and fibromyalgia. However, ‘The Journal of Pain,’ I swear I thought it was June of last year, but I do know there was also an article in November of last year where they really started talking about small fiber peripheral neuropathy and fibromyalgia.

Dr. Martin Rutherford: Right.

Dr. Randall Gates: First of all, we need to explain peripheral neuropathy. Peripheral neuropathy is where the peripheral nerves start to dysfunction. We have a central nervous system and nerves that go out to our arms, our hands, and our feet. Diabetics commonly have peripheral neuropathy, and it accounts for 50% of the peripheral neuropathy cases in our country.

That being said, neuropathy basically involves the nerves out here in your arms, your hands, or your legs dying or dysfunctioning. Usually there’s an underlying metabolic cause like diabetes, like an auto-immune problem that causes those nerves to die.

There are many different types of nerves. Some are big. Some are little. The little ones are called small fiber neuropathies, and the little ones encode pain. That’s what you need to get, pain. This ‘Journal of Pain’ in November of 2013 demonstrated that upwards of 41% of fibromyalgia patients have small fiber neuropathy. This was…

Dr. Martin Rutherford: And the point being patients come to our office, I have fibromyalgia. Other patients come to the office, we have peripheral neuropathy.

Dr. Randall Gates: Right.

Dr. Martin Rutherford: A lot of people don’t know that they have kind of both. Again, usually it will come out in the exam, and it was kind of something that’s been interesting. That’s why this is kind of an exciting breakthrough for us to understand better what’s going on.

Dr. Randall Gates: Exactly, because we were seeing it clinically…

Dr. Martin Rutherford: Yeah.

Dr. Randall Gates: …before it came out in these studies.

Dr. Martin Rutherford: Before it came out in the studies.

Dr. Randall Gates: In essence, in the study they went and they took a little piece of skin out. They can look at it under a microscope how many small fiber nerves…

Dr. Martin Rutherford: Right.

Dr. Randall Gates: …are there, and they see fewer of them in fibro patients versus control patients. This is a really novel finding, as Dr. Rutherford said, because it’s changing our understanding on fibromyalgia. And now we do have what’s termed a peripheral mechanism for fibromyalgia.

We’ve known for the last 20 years, there’s no inflammation in the muscles. We’ve known that the problem was largely in the spinal cord or in the brain. Now, we’re starting to see there can be a problem in the small fiber nerves out here, in the extremities most commonly. Just know that is the skinny on fibromyalgia and small fiber neuropathy.

We’ve gotten feedback that many of you are on fibromyalgia message boards, and this has been talked about. We wanted to do this little exposé so that you can get a better understanding of really the nuances of what’s happening.

If you have any more questions you can go to We have more broadcasts there. We have full hour long presentations on fibro.

Was there anything else you wanted to…

Dr. Martin Rutherford: And peripheral neuropathy.

Dr. Randall Gates: And peripheral neuropathy.

Dr. Martin Rutherford: And peripheral neuropathy.

Dr. Randall Gates: Is there…

Dr. Martin Rutherford: And now it’s probably going to come together that they’re basically…

Dr. Randall Gates: The same thing.

Dr. Martin Rutherford: …the same thing and they just are manifesting for some reason in some people. I have both, by the way.

Dr. Randall Gates: Yes you do.

Dr. Martin Rutherford: I’ve had both, okay. It’s part of how I got into this. For some people ,it’s going to manifest in the fibromyalgia, the super sensitivity. Some people it’s going to manifest in you having pain, numbness, tingling, burning in your feet. In some people, it’s going to manifest in both.

I think where it’s going it sounds like it’s the same thing. When we do this, frankly, it’s like it’s a little bit formal, but this is kind of how we talk. Off hand, I was going to say frankly we’re getting close to where it’s almost the same treatment in a sense…

Dr. Randall Gates: Right.

Dr. Martin Rutherford: …that you might even do the same thing for peripheral neuropathy patients relative to the fibro patients relative to the stimulations that we do in the feet, that we do for the peripheral neuropathy patients. It’s kind of logical to do it if a person has foot pain, and it might be kind of counterintuitive to do electrical stimulations to the feet for somebody where comes in with this sensitivity all over the place, but it does sound like it’s going into the same place…

Dr. Randall Gates: Exactly.

Dr. Martin Rutherford: …which simplifies things for us a lot. Okay, I think that’s it.

Dr. Randall Gates: Okay, perfect. Well, thank you for watching.

Dr. Martin Rutherford: I got my 2 cents in.

Dr. Randall Gates: Again, if you have any other questions go to

Dr. Martin Rutherford: Okay.