Possible cause, cure for widespread chronic pain

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BOSTON - Many patients who experience chronic pain throughout their body are told it's all in their head, but new research has revealed a possible cause and cure.

Laura Waslo is passionate about the guitar, but in 2009 chronic widespread pain prevented her from playing. 

"It was a burning pain in my legs and then also my feet, which were getting red and swollen all the time," said Laura Waslo.

Several doctors told Laura it was nerve damage from her diabetes, but no one could make the pain go away.  That is until she met Dr. Anne Louise Oaklander, MD, PhD, an Associate Professor of Neurology, HMS, Assistant in Pathology (Neuropathology), at Massachusetts General Hospital. Oaklander diagnosed Waslo with autoimmune neuropathy.

"This is a particular type of widespread nerve damage that is different from the diabetic neuropathy," said Oaklander.

Although it's been diagnosed in adults, Oaklander's study of 41 patients found it also occurs in those under 21.

"Since no one knew what the cause of their pain and other symptoms were, there were no effective treatments," Oaklander said.

In addition to chronic pain, Waslo experienced insomnia, blood pressure swings, and sometimes passed out when she stood up.

Through skin biopsies, and heart and blood pressure tests, doctors discovered neuropathy in younger patients.

"We were seeing abnormal skin biopsy test results or abnormal autonomic function test results. These are things that previously had not been described in young patients," said Dr. Max Klein, an Instructor in Neurology at Massachusetts General Hospital.

Waslo's pain level dropped with steroid treatment followed by transfusion therapy.

"I feel great now. My symptoms pretty much disappeared," she explained.

Other symptoms of autoimmune neuropathy include—numbness, tingling, and decreased reflexes. Some patients say their widespread chronic pain was brought on by an earlier illness, infection, or injury.

Additional Information:

SMALL-FIBER PERIPHERAL NEUROPATHY (SFPN):  Adult onset of small-fiber peripheral neuropathy, also called autoimmune neuropathy, is a well-known cause of chronic pain in middle aged adults and beyond.  However, "the idea that previously healthy children, teens, and young adults could develop this is somewhat of a new concept," Dr. Anne Louise Oaklander at Massachusetts General Hospital in Boston was quoted as saying.  A recent study of childhood-onset chronic pain could change the way that clinicians evaluate and treat unexplained pain in kids.  Dr. Anne Louise Oaklander and Dr. Max Klein say that 59 percent of 41 young patients they studied with unexplained chronic pain could be diagnosed with small-fiber peripheral neuropathy, and another 17 percent were classified as "probable" cases.  Researchers hope that the classification of this syndrome, which the authors call juvenile-onset small-fiber neuropathy, or JOSeFiNE, will influence the way doctors think about pain, and offer them possible treatment options.  (Source: painresearchforum.org/news/25893-new-cause-unexplained-pain-children)

EXPANDING KNOWLEDGE:  In older adults, small-fiber peripheral neuropathy is most often caused by vitamin deficiency, cancer, diabetes, or chemotherapy.  It involves the loss of the small, mostly unmediated sensory and autonomic nerve axons in the peripheral nervous system.  An objective diagnosis is made by skin biopsy showing loss of nociceptive epidermal nerve fibers and by tests of autonomic function.  However, this kind of diagnosis is not usually recommended in patients whose chronic widespread pain began in childhood or adolescence.  In 2007, Dr. Oaklander described a healthy 20 year old man who developed burning pain with redness and swelling of his hands and feet.  She diagnosed him with SFPN.  After that she said that she started to notice more and more cases in younger patients, leading to a new study. (Source: painresearchforum.org/news/25893-new-cause-unexplained-pain-children)

NEW STUDY:  In the new study, Dr. Oaklander and Dr. Max Klein analyzed all the clinical data from 41 patients, who were under 21 when their pain began.  Based on results from skin and nerve biopsies and physiological measures of autonomic function, more than half of the patients met diagnostic criteria for SFPN.  Some patterns did emerge from the medical histories.  A third of the patients had a history of autoimmune disease, and may displayed immune-related abnormalities on blood tests.  In some of the children, tests detected autoantibodies to voltage-gated potassium channels (VGKC) or N-type calcium channels, molecules that have recently been implicated in chronic pain. (Source: painresearchforum.org/news/25893-new-cause-unexplained-pain-children)

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