Clinical association of vitamin D and serotonin levels among patients with fibromyalgia syndrome

Assessing the Impact of IL-6 and Serotonin on Pain and Symptomatology in Fibromyalgia: An Exploratory Clinical Study

BACKGROUND AND OBJECTIVES

Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome characterized by widespread pain and a variety of other symptoms, including fatigue, cognitive dysfunction, and sleep disturbances. Recent research has highlighted the potential role of pro-inflammatory cytokines and neurotransmitters in the pathophysiology of FM. This study aimed to investigate the relationship between serum levels of interleukin-6 (IL-6) and serotonin with the clinical parameters observed in patients with fibromyalgia. Additionally, it sought to analyze the similarities and differences among the different groups classified by symptom severity.

MATERIALS AND METHODS

This cross-sectional study included 26 female patients aged 20-70 diagnosed with FM according to the American College of Rheumatology (ACR) 2016 criteria and 14 healthy controls (HCs). Serum levels of IL-6 and serotonin were measured using electrochemiluminescence and high-performance liquid chromatography (HPLC), respectively.

RESULTS

FM patients exhibited significantly higher pain scores (VAS), anxiety, and depression levels compared to HCs. FIQ-R scores were significantly elevated in FM patients, with stratification showing 3.8% mild, 65.4% moderate, 23.1% severe, and 7.7% very severe cases. While no significant difference in IL-6 levels was observed between the FM patients and HCs, a trend towards increased IL-6 levels in patients with higher FIQ-R scores was noted. Serum serotonin levels were significantly lower in the FM patients than in the HCs, with moderate patients having lower levels than those classified as severe and very severe.

CONCLUSIONS

The study underscores the potential role of IL-6 and serotonin in the pathophysiology of FM, suggesting that these biomarkers could be relevant in assessing the severity and impact of FM. Further research is needed to elucidate these relationships and their implications for developing personalized treatment strategies.

Pharmacological Treatment of Fibromyalgia Syndrome: A Practice-Based Review

PURPOSE OF REVIEW

Fibromyalgia Syndrome (FMS) is a complex chronic pain condition characterized by widespread musculoskeletal pain and numerous other debilitating symptoms. The purpose of this review is to provide a comprehensive overview, based on everyday clinical practice, of the drugs presently employed in the treatment of FMS.

RECENT FINDINGS

The treatment of FMS is based on a multimodal approach, with pharmacologic treatment being an essential pillar. The drugs used include tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, other antidepressants, anticonvulsants, myorelaxants, and analgesics. The effectiveness of these medications varies, and the choice of drug often depends on the specific symptoms presented by the patient. Many drugs tend to either address only some domains of the complex FMS symptomatology or have a limited effect on pain. Each treatment option comes with potential side effects and risks that necessitate careful consideration. It may be beneficial to divide patients into clinical subpopulations, such as FMS with comorbid depression, for more effective treatment. Despite the complexities and challenges, the pharmacological treatment remains a crucial part for the management of FMS. This review aims to guide clinicians in prescribing pharmacological treatment to individuals with FMS.

The effect of vitamin D treatment on quality of life in patients with fibromyalgia

BACKGROUND

Fibromyalgia is a syndrome characterized by chronic widespread pain accompanied by fatigue, disrupted sleep quality, cognitive impairments, subjective soft tissue swelling, and somatic symptoms. There are conflicting results in the literature regarding the prevalence of vitamin D deficiency in fibromyalgia patients and the reduction of symptoms after supplementation.

AIMS

Our study aims to evaluate the effectiveness and reliability of vitamin D supplementation in patients diagnosed with fibromyalgia.

METHODS

In our cross-sectional clinical study, 180 female patients aged 18 to 65 diagnosed with fibromyalgia according to the 2010 American College of Rheumatology Diagnostic Criteria were included. Oral vitamin D3 replacement of 50,000 IU was administered for 12 weeks. Patients' Fibromyalgia Impact Questionnaire (FIQ)and Visual Analogue Scale (VAS) scores were evaluated before and after the study.

RESULTS

Significant differences were observed in the FIQ scores of the 180 fibromyalgia patients before and after vitamin D supplementation (p < 0.05). There was also a significant improvement in VAS scores (p < 0.01). A negative correlation between vitamin D and VAS as well as FIQ scores was found in the study.

CONCLUSION

We determined that vitamin D deficiency is significantly more prevalent in patients diagnosed with fibromyalgia. Vitamin D supplementation was observed to have a positive effect on quality of life and reduction of pain.

Prevalence of fibromyalgia syndrome in Saudi Arabia: a systematic review and meta-analysis

BACKGROUND

The current systematic review and meta-analysis was conducted to estimate the prevalence of fibromyalgia syndrome (FMS) in Saudi Arabia.

METHODS

A PRISMA systematic search appraisal and meta-analysis were conducted. A systematic literature search of English publications in PubMed, Embase, PsycINFO, Web of Science, MEDLINE, and Google Scholar, was conducted up to December 2022. Generic, methodological and statistical data was extracted from the eligible studies. Meta-analysis was done using Comprehensive Meta-Analysis Software. The effect size estimates were calculated using the Fail-Safe N test. The funnel plot, Begg's and Mazumdar's rank correlation tests were employed to find any potential bias. The strength of the association between two variables is assessed using Kendall's tau. A fixed-effects model for the meta-analysis.

RESULTS

The literature search yielded a total of 2479 studies. Eight papers were included in the final analysis with sample size ranging 40 to 1686. All studies were cross-sectional except two, which were retrospective. The total number of the participants recruited in the included articles was 4967 (1794 males and 3173 females); with age ranged between 20 and 79 years. There was high heterogeneity among studies articles (Q = 270.187; p-value 0.001); the tau value was 0.179. The pooled event rates and the 95% confidence intervals (CIs) for the prevalence of FMS in Saudi Arabia in a fixed-effects model was 13.4% (95% CI: 0.124-0.144).

CONCLUSION

Our results clearly demonstrate that FMS is highly prevalent (13.4%) in Saudi Arabia. It also more common among women. The high prevalence of FMS in Saudi Arabia should be seriously considered and planners should take steps to reduce it.

Evaluation and Medical Management of Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a challenging condition affecting an estimated 15% of females in the United States. Multiorgan system dysfunction results in the complex clinical pain presentation. Similar to other chronic pain syndromes, CPP is influenced by biopsychosocial factors and requires a multimodal approach for optimal pain management. This review summarizes the clinical evaluation and medical management of CPP with a comprehensive approach.

Vitamin D may alleviate irritable bowel syndrome by modulating serotonin synthesis: a hypothesis based on recent literature

A number of studies found that serotonin plays a vital role in the development of depression and irritable bowel syndrome. Recent studies showed that vitamin D was associated with regulating the synthesis of serotonin. This review focuses on the recent progress in the relationship between vitamin D and serotonin synthesis.

The preventive role of vitamin D in the prevention and management of Fibromyalgia syndrome

Aim: Vitamin D deficiency is a prevalent condition among the general population, all around the world. Vitamin D deficiency is defined as serum levels of 25-hydroxy vitamin D lower than 20 ng/ml (50 nmol/ml). It is a known actor in the skeletal system through the regulation of calcium and phosphate metabolism and bone mineralization. Still, the role of vitamin D as an immunomodulator is yet to be acknowledged by healthcare practitioners as a cause, precipitating factor, and contributor to a variety of diseases. Vitamin D is shown to be an actor in multiple sclerosis, rheumatoid arthritis, insulin-dependent diabetes mellitus, and irritable bowel syndrome. Fibromyalgia syndrome (FMS) is a chronic disorder associated with a severe pain that can affect a patient's musculoskeletal system, daily routine, and mood. The clinical presentation encapsulates other disorders such as lethargy and sleep problems, brain fog and other cognitive issues, and physical and psychiatric symptoms. Methods: We have used PubMed and ResearchGate in the reviewing process of our paper. We tried to address as many topics as we judged to be adequate and relevant for the practicing clinicians. Results: Management of fibromyalgia syndrome is both nonpharmacologic and pharmacologic, which are provided in a stepwise fashion. Yet, the management of FMS remains a challenge, heeding a multidisciplinary approach. Among the dietary interventions, we chose vitamin D and its effects on FMS. Literature shows that supplementation improves pain caused by fibromyalgia syndrome, yet specific recommendations are still to be created. Conclusions: We call on all the relevant governmental bodies, public health experts and health policy makers, healthcare practitioners, and the civil society to use novel data related to fibromyalgia syndrome, and in a broader perspective, the integral role of vitamin D.

Can the Combination of Rehabilitation and Vitamin D Supplementation Improve Fibromyalgia Symptoms at All Ages?

Several studies have indicated a correlation between vitamin D deficiency and widespread chronic pain syndromes, such as fibromyalgia. During this study, the effect of supplementation with vitamin D in association with physical exercise in patients with fibromyalgia was evaluated, in terms of improvement of pain, functional capacity and quality of life, also evaluating the presence of any differences in age. A single-center, observational, comparative study was conducted in 80 fibromyalgia patients. They are randomized into 2 groups: Group A, consisting of patients ≤50 years; and group B, consisting of patients >50 years. Both received weekly supplementation with 50,000 IU cholecalciferol for 3 months in association with a rehabilitation protocol. Patients were assessed at enrollment (T0), 3 months (T1), and 6 months (T2) from the initial assessment with blood vitamin D dosage and administration of rating scales (NRS, FIQ, and SF-12). From the comparison between the two groups, we have seen that in young people, supplementation with high-dose vitamin D improves short-term musculoskeletal pain and long-term functional capacity. Conversely, musculoskeletal pain and long-term quality of life improve in the elderly. Supplementing with high doses of vitamin D in fibromyalgia patients improves the quality of life and pain in the elderly and also the functional capacity in the young.

The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia: A Narrative Review

INTRODUCTION

The multifaceted clinical presentation of fibromyalgia (FM) supports the modern understanding of the disorder as a more global condition than one simply affecting pain sensation. The main pharmacologic therapies used clinically include anti-epileptics and anti-depressants. Conservative treatment options include exercise, myofascial release, psychotherapy, and nutrient supplementation.

METHODS

Narrative review.

RESULTS

Nutrient supplementation is a broadly investigated treatment modality as numerous deficiencies have been linked to FM. Additionally, a proposed link between gut microbiome patterns and chronic pain syndromes has led to studies investigating probiotics as a possible treatment. Despite positive results, much of the current evidence regarding this topic is of poor quality, with variable study designs, limited sample sizes, and lack of control groups.

CONCLUSIONS

The etiology of FM is complex, and has shown to be multi-factorial with genetics and environmental exposures lending influence into its development. Preliminary results are promising, however, much of the existing evidence regarding diet supplementation is of poor quality. Further, more robust studies are needed to fully elucidate the potential of this alternative therapeutic option.

Efficacy and safety of weekly vitamin D3 in patients with fibromyalgia: 12-week, double-blind, randomized, controlled placebo trial

INTRODUCTION

FM is a chronic musculoskeletal disorder characterized by the presence of generalized pain. There are contradictory results regarding the prevalence and supplementation effect of vitamin D deficiency on FM patients. We aim to determine the safety and efficacy of a 12-week vitamin D supplementation on FM patients.

METHODS

We conducted a randomized, placebo-controlled, double-blind clinical trial. We included female participants of 18 years old or older, who met 1990 or 2010 ACR criteria for fibromyalgia. The Spanish validated FIQ and the VAS of pain were applied at baseline. The participants were then randomized to receive placebo or 50,000 IU of Vitamin D₃ PO, weekly for 12 weeks.

RESULTS

We included 80 patients. There was no statistical difference in the initial and final FIQ between both groups. The FIQ delta also did not prove to be different at the end of the study. The increase in vitamin D levels in the intervention group was corroborated. Regarding serious adverse effects, none was reported in both groups. There was no statistical difference in minor adverse events.

CONCLUSION

In this double-blind placebo-controlled randomized study conducted to measure the efficacy and safety of vitamin D exclusively in patients with FM, we found that there is no evidence of a trend in favor of vitamin D treatment, since we did not observe improvement in the VAS of pain or FIQ.

TRIAL REGISTRY

Clinical Trials.gov number: NCT03369379 Key Points • There are conflicting results in vitamin D to treat fibromyalgia. • In this double-blind, randomized controlled trial, we did not find a difference in the VAS nor FIQ with vitamin D supplementation. • The increase in vitamin D levels in the intervention group was corroborated.