What is “Man on Fire” Syndrome and What Does it Do?

Man on Fire syndrome is a genetic, inherited disease. The disease happens when certain blood vessels become blocked and unblocked frequently.

If you were to put your bare hand on a stove that was turned on high, you would most likely immediately pull it away, due to the burning, intense pain, but just walking your dog or participating in some other normal activity wouldn’t result in such pain for most people.

However, for those who live with erythromelalgia, otherwise known as “Man on Fire” syndrome, excruciating, terrible pain can be a normal part of their life, caused by activities as simple as getting dressed in the morning or walking to the front door. Erythromelalgia is a rare disease that significantly impacts the nervous system and causes chronic pain in one’s body, especially in the legs, hands, and feet.

What is it?

The vessels can then become swollen when the blood flow to the tissues increases and inflamed. This causes severe, burning pain, usually either a radiating or shooting type, in the fiber sensory nerves that are found along the spinal cord. However, the pain usually isn’t quick or dull but is sharp and slow. These instances vary in frequency from patient to patient and can be attributed to heat, pressure, exertion, or stress, even in the smallest degrees. Many people who suffer from Man on Fire syndrome explain that putting on socks or shoes is something that can also trigger an attack.

Why Does it Happen?

As mentioned above, erythromelalgia is inherited, but the reason for the pain goes deeper and deals with specific nerves. C-fiber nerves that line the spinal cord have channel proteins in them, which allow messages to be transmitted within and through the nerves. One of these specific channel proteins in the C-fibers in the Nav1.7, which is present in great numbers in the C-fibers.

The Nav1.7 channels can have a defect that allows many sodium ions into the nerves, which in turn increases the sensitivity in the nerves and can be responsible for the intense pain those with Man on Fire syndrome experience. The defect of these channels is not the same in all patients, which can cause some to have more or more intense pain than others. The other extreme concerning chronic pain is Congenital Insensitivity to Pain or CIP.

Patients who suffer from CIP can’t feel pain at all, which may sound like a great thing on the surface, but pain serves to tell humans when they are in danger. A person with CIP can be harmed and not know it, and they may not be able to have the proper response to pain or may not be able to describe their pain at all.

Patients with CIP have a completely dysfunctional Nav1.7 channel, which accounts for part of their disease, but CIP is also caused because of increased production of endorphins in the brain.

How Can it be Treated?

There is currently no treatment that can completely cure Man on Fire syndrome, but there are things that can help with the pain. It is always possible to attempt to stop the attacks before they begin and try to curb the triggers of the pain, but this can be hard to do when dealing with erythromelalgia, as patients don’t always know what exactly will cause pain and when the attacks will come on.

A treatment that can be done at home or by a patient themself is called a “cooling treatment”. People affected by Man on Fire will ice their feet or the area that causes them the most pain or place their feet, hands, or arms on another cool surface. However, this can be dangerous, and some patients participate in these cooling treatments to the point where they risk injuring themselves.

As for medication that can be used to treat erythromelalgia, there isn’t yet one specifically for the disease. The drug Carbamazepine is sometimes prescribed but doesn’t work for all patients. Morphine, aspirin, and ibuprofen are medicines well-known for relieving pain, but they impact other areas of the body and can have side effects. Neuroscientists and other researchers are looking to invent a drug that would target the Nav1.7 channel, since they aren’t found in very many places outside of the spinal cord, and a medication that would block the channel wouldn’t have very many side effects.

With the new technology and potential experiments at our disposal, researchers, doctors, and scientists are learning more and more about Man on Fire and its counterpart, CIP, and hope to apply their knowledge to creating treatments and medications that would help people around the world suffering from both chronic pain and lack thereof.