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Unique, separate sensory system discovered in skin - Could help explain fibromyalgia & other ‘pain of unknown sources’

  [ 57 votes ]   [ 5 Comments ]
By Albany (NY) Medical College • • December 10, 2009

“Much to our surprise, the skin we received from England lacked all the nerve endings that we normally associated with skin sensation. So how were these individuals feeling anything?"

The human sensory experience is far more complex and nuanced than previously thought, according to a groundbreaking new study published in the Dec 15 issue of the journal Pain.(1) In the article, researchers at Albany Medical College, the University of Liverpool, and Cambridge University report that the human body has an entirely unique and separate sensory system aside from the nerves that give most of us the ability to touch and feel.

Surprisingly, this sensory network is located throughout our blood vessels and sweat glands, and is for most people largely imperceptible.

"It's almost like hearing the subtle sound of a single instrument in the midst of a symphony," said senior author Frank Rice, PhD, a Neuroscience Professor at Albany Medical College (AMC), who is a leading authority on the nerve supply to the skin.

"It is only when we shift focus away from the nerve endings associated with normal skin sensation that we can appreciate the sensation hidden in the background."

The research team discovered this hidden sensory system by studying two unique patients who were diagnosed with a previously unknown abnormality by lead author David Bowsher, MD, Honorary Senior Research Fellow at the University of Liverpool's Pain Research Institute.

These patients had an extremely rare condition called congenital insensitivity to pain, meaning that they were born with very little ability to feel pain. Other rare individuals with this condition have excessively dry skin, often mutilate themselves accidentally and usually have severe mental handicaps. "Although they had a few accidents over their lifetimes, what made these two patients unique was that they led normal lives. Excessive sweating brought them to the clinic, where we discovered their severe lack of pain sensation," said Dr. Bowsher.

"Curiously, our conventional tests with sensitive instruments revealed that all their skin sensation was severely impaired, including their response to different temperatures and mechanical contact.

"But, for all intents and purposes, they had adequate sensation for daily living and could tell what is warm and cold, what is touching them, and what is rough and smooth."

The mystery deepened when Dr. Bowsher sent skin biopsies across the ocean to Dr. Rice's laboratory, which focuses on multi-molecular microscopic analyses of nerve endings in the skin, especially in relation to chronic pain conditions such as those caused by nerve injuries, diabetes, and shingles. These unique analyses were pioneered by Dr. Rice at Albany Medical College (AMC) along with collaborators at the Karolinska Institute in Stockholm, Sweden.

"Under normal conditions, the skin contains many different types of nerve endings that distinguish between different temperatures, different types of mechanical contact such as vibrations from a cell phone and movement of hairs, and, importantly, painful stimuli," said Dr. Rice. "Much to our surprise, the skin we received from England lacked all the nerve endings that we normally associated with skin sensation. So how were these individuals feeling anything?"

The answer appeared to be in the presence of sensory nerve endings on the small blood vessels and sweat glands embedded in the skin.

"For many years, my colleagues and I have detected different types of nerve endings on tiny blood vessels and sweat glands, which we assumed were simply regulating blood flow and sweating. We didn't think they could contribute to conscious sensation. However, while all the other sensory endings were missing in this unusual skin, the blood vessels and sweat glands still had the normal types of nerve endings. Apparently, these unique individuals are able to 'feel things' through these remaining nerve endings," said Dr. Rice.

"What we learned from these unusual individuals is that there's another level of sensory feedback that can give us conscious tactile information. Problems with these nerve endings may contribute to mysterious pain conditions such as migraine headaches and fibromyalgia, the sources of which are still unknown, making them very difficult to treat."

In addition to international collaborations such as this one, Dr. Rice and his principle AMC colleague, Dr. Philip Albrecht, in the Center for Neuropharmacology and Neuroscience, collaborate extensively with neurologists Dr. Charles Argoff at AMC and Dr. James Wymer of Upstate Clinical Research Associates, who also holds a joint AMC appointment. All are co-authors on the study, which included normal subjects from the Albany, New York, area. Several studies on chronic pain are being conducted by this team with support from National Institutes of Heath (NIH) and several pharmaceutical companies.

About Integrated Tissue Dynamics (INTIDYN)

To facilitate these collaborations, Dr. Rice and Dr. Albrecht recently founded a new biotechnology company, Integrated Tissue Dynamics, LLC, also known as Intidyn ( Intidyn provides flexible and scalable research capabilities on behalf of pharmaceutical companies to detect chemical and structural changes in the skin that may cause the chronic numbness, pain and itch associated with a wide variety of afflictions such as diabetes, shingles, complex regional pain syndrome, carpal tunnel syndrome, sciatica, fibromyalgia, psoriasis, chemotherapy and even the unintended side effects caused by many drugs. Such afflictions and the associated neurological problems respond poorly to existing treatments. The preclinical and clinical research conducted by AMC and Intidyn facilitates biomarker identification and the evaluation of potential therapeutic strategies to prevent or treat these naturally-occurring afflictions and drug-induced side effects that harm the skin and nerves.

"By looking carefully at genomics and the structural and chemical differences between normal and diseased skin, we can better determine if a treatment is working or if it's even targeting the right problem," said Dr. Rice. "For example, in cases of 'unexplained' pain that's unresponsive to conventional treatment, it's important to know if nerve receptors in the vascular and sweat gland tissue are involved, and if so, whether a given treatment is targeting those nerves. We can also see if a pain treatment is damaging vascular tissue, for example, and make inferences about what the impact of that damage might mean clinically."

Most recently, Intidyn has partnered with neurologists and fellow co-authors, Drs. Argoff and Wymer to study a mysterious condition called fibromyalgia. They suspect the unrelenting pain may be related to the sensory nerve endings on blood vessels deep in the skin.

1. Citation:  “Absence of pain with hyperhidrosis: A new syndrome where vascular afferents may mediate cutaneous sensation,” ) Bosher D, Rice FL, et al. Pain, Dec 15, 2009.

Source: Albany (NY) Medical College (/ news release, Dec 9, 2009

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Article Comments Post a Comment

Skin Hypothesis - central pain hypothesis
Posted by: KerryK
Dec 10, 2009
I believe the skin hypothesis will bear fruit, though not necessarily in the receptors mentioned in the article. However, if the disease lives in the skin, that very simply, neatly explains the widespread pain and the so-called central pain sensitization hypothesis. I hope we can soon discard the lables "functional somatic" and "muscle pain".
Reply Reply

Unique, separate sensory system discovered in skin - Could help explain fibromyalgia & other ‘pain o
Posted by: lsobol
Dec 16, 2009
Interesting and curious. To say these people suffer from mental disease seems cruel. Migraines and fibromyalgia are very mental, i.e. CNS (Central Nervous System). To say people like this tend to have no feelings in their body or to heat etc. is not true in most cases, I would say. I never had any problem with pain recognition or sensation. I have blocked pain and painful experiences in my anyone who wants to forget pain would do. You definately need more research because while you may be on track in a minor way such as the discoveries, to make them worth while, it would be best to not label people in bulk fashion saying they are all mental cases!
Reply Reply

skin sensation
Posted by: jacquesvaniseghem
Dec 30, 2009
I think this is a major discovery . For me it has to deal with the so unknown neurovegetatif system that could possibly have this sensory endings .The sensations these patients still feel are completely typical for a failure of this system
Reply Reply

unique sensory system
Posted by: harboreen
Dec 30, 2009
Curious to me is the SWEATING issue. I've suffered with fibromyalgia (severely) for some fifteen yrs now yet it's only within the past five/six that sweating has become a major nuisance/issue. Can/is sweating possibly a pain blocker? A pain increaser? A result of an increase in pain? (which seems to be justified in my case)
Reply Reply

at long last
Posted by: justplainsandi
Jan 23, 2010
i'm so relieved that this has finally been "discovered." isn't it interesting how scientists say they've discovered something when they've merely learned that they've been wrong for a very long time? i've worked within science, mentored, edited, and typed dissertations, argued research progress, and have earned the right to laugh at that strange breed. i also remember being laughed at when i was a little girl because i said that my skin hurt. i've watched how small children respond to the information that they take in through their skin and are gradually taught to stop paying attention as they grow older. i guess i was too stubborn to learn, and my skin never stopped hurting, the hurt just getting deeper. i just learned to not pay attention until i hit bottom and almost killed myself in the process when all my systems shut down. traditional oriental medicine has been the key to my survival ever since, along with help from nutritional supplements and some little input from the western practices i barely trust. acupuncture works through the integrative processes that are accessed through the surface of the skin.
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