A Link Between Inflammatory Mechanisms and Fibromyalgia

Nano-pregabalin effectively mitigates Glut, CGRP and NE neurotransmitters abnormalities in the brain of gamma irradiated rats with reserpine-induced fibromyalgia model: Behavioral and neurochemical studies

AIMS

Fibromyalgia (FM) is an idiopathic syndrome with painful burdensome symptoms. Radiotherapy is one of the main therapeutic modalities for treating various malignancies and there is a probable association between FM exacerbation and exposure to ionizing radiation. Based on that nanomedicines progressively being explored for their promising applications in medicine, the aim of the current study is to assess the possible therapeutic benefits of nanoform of pregabalin (N-PG) in managing FM symptoms during being exposed to ionizing radiation.

MAIN METHODS

Rats were allocated into four groups. First group served as control, the other three groups received gamma radiation (2 Gy/day) after 1 h of reserpine administration (1 ml/kg per day, s.c.) to induce FM for three successive days. On the next day, third and fourth groups received (30 mg/kg, p.o.) of PG and N-PG, respectively once daily for ten consecutive days. Tail flick test was performed and von Frey filaments were used to assess mechanical allodynia/hyperalgesia, and then rats were sacrificed to obtain brains.

KEY FINDINGS

N-PG effectively replenished reserpine effects and treated both allodynia and hyperalgesia, improved thermal allodynia, effectively recovered all neurotransmitters near to normal baseline, inhibited oxidative stress status via decreasing malondialdehyde (MDA), increasing glutathione (GSH) and superoxide dismutase (SOD), it had strong anti-inflammatory effect as verified by reducing both cyclooxygenase-2 (COX-2) and nuclear factor kappa B (NF-kB) in addition to inhibition of intrinsic apoptosis through caspase-3 (casp-3) decrease and B-cell lymphoma-2 (Bcl-2) increase. Histopathological and immunohistochemical results confirmed the biochemical findings.

SIGNIFICANCE

N-PG could be a promising drug for treating FM especially when there is urgent need to expose patient to ionizing radiation.

Radio Electric Asymmetric Conveyer (REAC) Biomodulation for Chronic Pain and Functional Improvement in Rheumatoid Arthritis, Lipedema, and Fibromyalgia: A Case Study on Anti-inflammatory, Circulatory, and Metabolic Optimization

This case report explores the use of radio electric asymmetric conveyor (REAC) technology for chronic pain management, functional limitations, and metabolic dysfunction in a 67-year-old female with rheumatoid arthritis, advanced lipedema, and fibromyalgia. The patient underwent three REAC protocols: Anti-cellulite treatment (ACT), circulatory optimization (CO), and metabolic optimization (MO), each targeting distinct pathophysiological aspects. The ACT protocol primarily addressed chronic inflammation contributing to pain and tissue dysfunction associated with lipedema. The CO protocol enhanced joint mobility by improving systemic and local blood flow, relieving joint stiffness due to rheumatoid arthritis. The MO protocol focused on metabolic restoration to counter chronic fatigue linked to lipedema and fibromyalgia. SF-12 results showed a significant improvement in physical health index (50.88% to 68.16%) and mental health index (58.38% to 86.40%). Depression, anxiety and stress scale - 21 (DASS-21) scores indicated a decrease in the depression index (47.62% to 23.81%) and stress index (57.14% to 42.86%), with anxiety remaining stable at 23.81%. This case underscores REAC technology's potential as a non-invasive, multifaceted intervention addressing underlying inflammation, circulatory impairment, and metabolic dysregulation in complex chronic conditions, offering a valuable alternative to conventional treatments. Following treatment, the patient reported substantial reductions in pain and physical discomfort, increased mobility, and enhanced energy and emotional well-being. Improvements began after ACT, with decreased pain and increased ease in daily activities. CO further supported joint mobility, allowing tasks like walking and stair-climbing with less strain. MO led to greater overall vitality and mood stability, enabling a more active lifestyle. No significant adverse effects were reported. This case underscores REAC technology's potential as a non-invasive, multifaceted intervention addressing the underlying inflammation, circulatory impairment, and metabolic dysregulation in complex chronic conditions, offering a valuable alternative to conventional treatments. Further research could clarify REAC's broader applications in similar multifactorial cases.

Palmitoylethanolamide, an endogenous fatty acid amide, and its pleiotropic health benefits: A narrative review

The global nutritional transition has led to high frequency and severity of chronic degenerative diseases worldwide, primarily driven by chronic inflammatory stress. At the mealtimes, various pharmaceutical products aim to prevent such an inflammatory stress, they usually cause various systemic side effects. Therefore, supplementation of natural and safe ingredients is a great strategy to reduce the risk and severity of inflammatory stress-related diseases. As a result, palmitoylethanolamide (PEA), an endocannabinoid-like mediator, has been extensively studied for its myriad of actions, including anti-inflammatory, anti-microbial, immunostimulatory, neuroprotective, and pain-reducing effects with high tolerability and safety of PEA in animals and humans. Because of the multiple molecular targets and mechanisms of action, PEA has shown therapeutic benefits in various diseases, including neurological, psychiatric, ophthalmic, metabolic, oncological, renal, hepatic, immunological, rheumatological, and gastrointestinal conditions. The current review highlights the roles and functions of PEA in various physiological and pathological conditions, further supporting the use of PEA as an important dietary agent.

Heart Rate Variability Biofeedback Efficacy on Fatigue and Energy Levels in Fibromyalgia: A Secondary Analysis of RCT NCT0412183

Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically those related to perceived energy and fatigue symptoms in a randomized controlled trial (RCT) assessing the efficacy of heart rate variability biofeedback (HRV-BF) as an adjunctive treatment for FMs. Methods: Sixty-four FMs patients were randomly assigned to either receive 10 HRV-BF training sessions alongside standard pharmacological therapy (experimental group) or standard therapy alone for 10 weeks (control group). For this secondary analysis, potential improvements in specific items were evaluated regarding perceived energy (Item 10 of the Short-Form Health Survey), the ability to walk and climb stairs (Item 7 and Item 11 of the Fibromyalgia Impact Questionnaire, respectively), and the impact of pain on movement ability (Item 17 of the Bodily and Emotional Perception of Pain). Results: The experimental group demonstrated an improvement in the perception of energy, the ability to walk, and the impact of pain on movement ability. However, the same improvement was not observed in the ability to climb stairs. Conclusions: Fatigue assessment has emerged as a crucial factor for evaluating treatment efficacy in FMs and related conditions linked to altered energy levels, such as bipolar depression, and can offer valuable insights for precisely guiding HRV-BF treatments. ClinicalTrials.gov with code: NCT04121832.

Investigating the Effectiveness of a Carb-Free Oloproteic Diet in Fibromyalgia Treatment

Fibromyalgia (FM), a chronic disease with a high incidence in women, poses a significant challenge for diagnosis and treatment, especially due to the absence of specific biomarkers and the multifaceted nature of its symptoms, which range from neuromuscular pain to mood disorders and intestinal dysbiosis. While diagnosis currently relies on rheumatological clinical evaluations and treatment options mainly focus on symptom management, FM seems to have possible links with systemic metabolic dysfunctions with a common inflammatory root. In this context, a new therapeutic avenue emerges: could a therapeutic nutritional approach be the missing piece of the puzzle? Indeed, diet therapies employed particularly for metabolic syndromes proved recently to be efficacious for correcting systemic dysmetabolism and a high number of chronic inflammation conditions. In particular, the very-low-calorie ketogenic diet (VLCKD) demonstrated therapeutic benefits in many disorders. In the present study, we aimed to investigate the specific effects of two dietary interventions, namely the oloproteic VLCKD and the low-glycemic insulinemic (LOGI) diet, on two groups of female FM patients (FM1 and FM2) over a 45-day period. Utilizing clinical and laboratory tests, as well as non-invasive NMR metabolomic analysis of serum, urine, and saliva samples, we sought to uncover how these dietary regimens impact the metabolic dysfunctions associated with FM.

Exercise Training for Chronic Pain: Available Evidence, Current Recommendations, and Potential Mechanisms

Chronic pain conditions pose a significant global burden of disability, with epidemiological data indicating a rising incidence. Exercise training is commonly recommended as a standalone or complementary approach for managing various chronic pain conditions like low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, and neuropathic pain. Regardless of the specific condition or underlying cause (e.g., autoimmune disease, chronic inflammation), exercise training consistently leads to moderate to large reductions in pain. Moreover, exercise yields numerous benefits beyond pain alleviation, including small-to-moderate improvements in disability, quality of life, and physical function. Despite its efficacy, there is a lack of comprehensive research delineating the optimal intensity, duration, and type of exercise for maximal benefits; however, evidence suggests that sustained engagement in regular exercise or physical activity is necessary to achieve and maintain reductions in both clinical pain intensity ratings and the level that pain interferes with activities of daily living. Additionally, the precise mechanisms through which exercise mitigates pain remain poorly understood and likely vary based on the pathophysiological mechanisms underlying each condition.

The Role and Potential Mechanism of Complement Factor D in Fibromyalgia Development

Purpose

Fibromyalgia (FM) is a syndrome characterized by chronic musculoskeletal pain. Its clinical symptoms include both somatic and psychiatric symptoms, making the treatment of FM extremely challenging. The cause of FM is still unknown, and some patients do not improve their symptoms even after long-term active treatment. Thus, the development of new targeted therapies is important to reduce pain and improve quality of life for FM patients.

Methods

In this study, we screened genes and secreted factors that play key roles in FM through bioinformatics and big data analysis. Furthermore, we performed CCK-8, qRT-PCR, glucose, ATP and lactate content testing, dual luciferase reporter gene assay to investigate the potential mechanism of complement factor D in fibromyalgia development.

Results

In bioinformatics and big data analysis, we identified CFD was negatively correlated with the pro-inflammatory factor IL-6 and positively correlated with the anti-inflammatory factor IL-4, which suggested that CFD may be an anti-inflammatory factor. Through cellular assays, we verified that CFD reversed the decrease in IL-4 expression and the increase in IL-6 expression in BV2 cells caused by ATP.

Conclusion

In summary, based on bioinformatic methods and big data mining we obtained a new target CFD for FM, and further experiments verified that CFD has significant inhibition of ATP-induced neuropathic pain. These findings provide a new theoretical basis for the clinical translation of CFD.

Elevated high sensitive C-reactive protein in fibromyalgia

Introduction

Fibromyalgia syndrome (FMS) is a complex chronic pain condition characterized by widespread pain and tenderness, fatigue, and sleep disturbances. Currently, factors contributing to FMS are considered to be multifactorial, and the involvement of inflammatory processes is a question of debate.

Objective

The aims of this study were (1) to assess whether serum concentrations of high-sensitivity C-reactive protein (hsCRP) differ between individuals diagnosed with FMS and pain-free controls, (2) to determine whether these differences are associated with clinical symptoms, and (3) to explore whether the observed differences can be explained by specific covariates such as age, weight, and smoking status.

Methods

An ANOVA was applied to identify differences of hsCRP levels between FMS and pain-free controls and an analysis of covariance (ANCOVA) was performed to investigate the dependencies of hsCRP with respect to covariates. To assess the reliability of our findings, we also utilized a Bayesian robust estimation model to determine the level of confidence associated with our results.

Results

The results showed that individuals with FMS had higher hsCRP levels compared to healthy controls [F(1,106) = 8.802, p < 0.001] and that higher hsCRP levels were significant correlated with a higher symptom burden (r = 0. 287, p = 0.008) and more tender points (r = 0.307, p = 0.005). Further, hsCRP levels were significantly associated with weight (η2 = 0.154, p < 0.001), but independent of age (η2 = 0.005, p = 0.42), smoking status (η2 = 0.002, p = 0.623), or gender (η2 = 0.0045, p = 0.437), which resulted in an insignificant group effect between FMS and controls (η2 = 0.029, p = 0.052), even after controlling for covariates.

Conclusion

In conclusion, this study provides evidence that sub-inflammatory processes correlate with clinical symptoms, which can be partly attributed to differences in weight, but cannot be fully explained by them. Further research is needed to elucidate the mechanisms underlying the association between hsCRP and FMS and to explore the potential therapeutic implications of targeting hsCRP in the management of FMS.