Fibromyalgia syndrome is a chronic pain condition associated with autonomic symptoms, fatigue and cognitive disturbances. Despite the large body of studies on the topic, the mechanisms underlying this common chronic pain condition are still a matter of debate. However, recent preclinical investigations have indicated that dorsal root ganglia damage, due to circulating autoantibodies, may play a role in fibromyalgia. Accordingly, approximately 50% of patients with fibromyalgia have a reduced intraepidermal nerve fibre density as assessed with skin biopsy. This small nerve fibre loss, commonly defined as small-fibre pathology, may also underlie the multiple symptoms that patients with fibromyalgia experience, such as ongoing burning extremity pain, bladder and bowel disturbances. 

However, the relationship between small-fibre pathology and the symptoms and signs that patients with fibromyalgia experience is still an issue of controversy. Whereas several studies have reported that patients with fibromyalgia have impaired sensory profiles at the quantitative sensory testing and abnormal nociceptive evoked potentials, other studies showed that small-fibre pathology is not associated with clinically meaningful abnormalities of the somatosensory nervous system.

This workshop addresses the two opposite views on fibromyalgia. The first speaker, Jordi Serra, will detail all the evidence supporting a specific role of small-fibre pathology in patients with fibromyalgia. The second speaker, Andrea Truini, will provide evidence that the small-fibre pathology may have a negligible impact on symptoms that patients with fibromyalgia experience. 

The discussion will be led by the chair, Claudia Sommer.