There’s room for improvement in the treatment of fibromyalgia. Currently, doctors are blindly following results of large studies, which proved that a certain medicine only works a little bit on an average patient. We think this could be done differently.

Patients have the right to be treated as an individual, not as an average anonymous patient.

 

More creativity and insight necessary in the treatment of fibromyalgia patients

Treating fibromyalgia is not easy. Especially when the therapist doesn’t realize it’s a matter of a chronic, less active inflammation.

When treating the chronic pain symptoms of fibromyalgia, and the often-accompanying chronic fatigue, we need a little more insight and creativity than we usually see in practice.

After treating fibromyalgia patients for several years now we came to a new understanding. That fibromyalgia is NOT imaginary, but is an actual understandable pain syndrome, for which an innovative treatment is useful. For example, fibro patients have insufficient levels of the pain relieving, anti-inflammatory substance palmitoylethanolamide in the muscles. Recently we found that this actually explains the pain that many fibro patients experience when the exert themselves. [1] More about that below.

 

Fibromyalgia: common

Fibromyalgia is not uncommon. We see it among 5% of all women and 1% of all men. Some researchers describe fibromyalgia as a form of central sensitization, like the chronic fatigue syndrome and IBS syndrome. This means that parts of the nervous system translate weak pain stimuli in to very strong pain stimuli. This is due to the body’s own pain inhibiting systems being under-active. Which we believe has different causes.

 

Fibromyalgia: 2 important angles

There are two important aspects that we will discuss here: fibromyalgia due to reduced central pain inhibition and fibromyalgia as a mild chronic inflammation. These two aspects influence each other negatively so that patients can experience a lot of discomfort due to the pain and fatigue involved.

 

Fibromyalgia and reduced central pain receptors

One of the reasons why fibromyalgia patients experience so much pain is because there are less pain receptors in the brain. These are our own endogenous opioid receptors. Researchers of the university of Michigan (US) compared the central pain relieving receptors of fibromyalgia patients with those of healthy pain-free volunteers, and looked at the presence of so called mu-opioid receptors (MOR) by using a modern technique called positron emission tomography.

They clearly found reduced levels of these receptors among the fibromyalgia patients. For those of you that are interested, here are their findings:

We demonstrate that FM patients display reduced MOR binding potential (BP) within several regions known to play a role in pain modulation, including the nucleus accumbens, the amygdala, and the dorsal cingulate. MOR BP in the accumbens of FM patients was negatively correlated with affective pain ratings. Moreover, MOR BP throughout the cingulate and the striatum was also negatively correlated with the relative amount of affective pain (McGill, affective score/sensory score) within these patients. These findings indicate altered endogenous opioid analgesic activity in FM and suggest a possible reason for why exogenous opiates appear to have reduced efficacy in this population.[2]

This insight immediately helps us to understand why opiates don’t work well for fibromyalgia patients. [3] And it forms the basis of the treatment we are creating for our clinic right now. Because we’re trying to use a special pharmaceutical approach, called up-regulation, and low doses to increase the central anti-pain receptors in numbers. This is possible with LDN, which we will explain below. But first we will explain why fibromyalgia is probably a case of chronic inflammation.

 

Fibromyalgia as mild chronic inflammation

We believe this is due to the fact that there are more of the inflammation mediators, or cytokines, present in the blood with fibromyalgia. [4] These are the same ones we find with IBS and Crohn’s disease, a painful intestinal inflammation. And with the chronic fatigue syndrome. [5] An additional explanation is that fibromyalgia patients have lower levels of pain reducing receptors in the brain.

Fibromyalgia is a, still unexplained, pain syndrome subject to lots of speculation about what could be the cause. In any case, with fibromyalgia we see a couple of subtle abnormalities and the condition is a little similar to neuropathic pain. [6]

In our center we use a treatment that is based on the latest insights around the condition, the pathogenesis, of fibromyalgia. For example, with fibromyalgia more inflammatory protein is found in the blood compared to normal. This is part of the logic in using a supplement that contains 100% pure palmitoylethanolamide.

 

Immunological and neurophysiological abnormalities with fibromyalgia

Fibromyalgia as mild chronic inflammation. [7] The protein of the immune system that can be found in the blood in higher levels are called cytokines. [4][9] This type of subtle immunological abnormalities can also be found with neuropathic pain. But fibromyalgia also shows a neurophysiological phenomenon called sensitization. [10] In 2010, researchers from the US summarized the abnormalities of fibromyalgia as follows:

It is known that the neuroimmunoendocrine system has a role in the pathogenesis of the disease and multiple abnormalities have been demonstrated in the peripheral and central nervous systems[10]

 

Modern research on fibromyalgia

The titles of several modern studies from 2010 on the possible relationship between fibromyalgia and inflammation speak for themselves:

Integrated review of the association of cytokines with fibromyalgia and fibromyalgia core symptoms.

Neuroendocrine immunology of fibromyalgia.

Cytokines across the night in chronic fatigue syndrome with and without fibromyalgia.

 

Fibromyalgia taken seriously

Recent studies show that fibromyalgia is more than an imaginary condition. The fact that fibromyalgia is considered more and more as a serious illness becomes clear by the following. Three different pharmaceutically active substances have been admitted in the US to treat chronic pain and other symptoms of fibromyalgia. These substances only influence the central nervous system that causes the over sensitivity, or sensitization.

However, these substances cause negative side effects for many fibro patients, which make it impossible to continue. Because of this, new treatments with less side effects are necessary.

 

A new treatment for fibromyalgia and fibromyalgia related complaints

In our clinic we use a combination of treatments that are aimed towards reducing the cause of fibromyalgia. We are presuming the broadly supported understanding that fibromyalgia is a chronic pain syndrome that is connected to a subtle inflammation, which causes increased cytokines levels in the blood as well as sensitization and pain in the central nervous system.

To treat this cause we combined two methods, both with proven effectiveness, that synergistically work together.

The first part is a treatment with a low dose of a special substance called naltrexone, which strengthens the pain relieving ability of our body. By giving a very low dose, our body will respond to this substance by producing more of it’s own pain relieving substance, the so-called endogenous opiates. This may sound absurd, but our body produces its own opium-like and cannabis-like pain relieving substances. By giving a low dose of naltrexone, on top of producing more of the pain relieving substances, the body will also produce more receptors for its own pain relieving substance. This is called upregulation of opioid receptors.

The second part of the treatment is based on a natural bodily substance that resets the entire system. This is called palmitoylethanolamide, a very special substance that is available in capsules (400mg) and as a PEA cream that can be applied to the skin.

 

Fibromyalgia and palmitoylethanolamide (PEA supplement)

The PEA supplement, with the difficult name palmitoylethanolamide, is a natural molecule produced in our body, which has not only a natural pain relieving effect, but also an anti-inflammatory effect and brings balance to our body in important biological processes that have been thrown off balance with fibromyalgia. The starting dose is 400mf of PEA 3 times a day, preferably in combination with PEA cream or amitriptyline-PEA cream. The latter needs to be prescribed by a doctor.

On other pages of our site you can find more information on this supplement, which is easily combined with other medicine and has no negative side effects. We will continue to discuss naltrexone.

 

Fibromyalgia and naltrexone

We are not the first ones to find the relationship between increasing our body’s own opioids and treating fibromyalgia.

A study was conducted by the academic anesthesiologists, doctor Jarred Younger and doctor Sean Mackey of the School of Medicine, Department of Anesthesia, Division of Pain Management, Stanford University, Palo Alto, California, in de USA.

In this study, the anesthesiologists gave a number of patients with fibromyalgia a low dose of naltrexone and examined the decrease of pain caused by that treatment. We can see the results in the table below.

The authors summarize the results as follows:

LDN reduced Fbromyalgia symptoms by 30.2% over and above placebo. Speciïal symptoms, including average pain, highest pain, fatigue, and stress, were also significantly impacted by the drug. The observed effects were accompanied by a very low incidence of side effects, suggesting LDN may be an effective and well-tolerated treatment option for individuals with fibromyalgia.

The side effects we minimal, a few patients experienced passing nausea, sleeplessness and vivid dreams.

These findings are in line with recent outcomes of the study from the university of Michigan as was discussed above. Due to LDN the level of receptors in the brain increases, which causes the pain relieving substances that are produced by the body to work better.

Information for doctors and specialists about PEA

 

References

[1] Koltyn KF1, Brellenthin AG2, Cook DB2, Sehgal N3, Hillard C4. | Mechanisms of Exercise-Induced Hypoalgesia. | J Pain. | 2014 Sep 23. pii: S1526-5900(14)00915-8. doi: 10.1016/j.jpain.2014.09.006. [Epub ahead of print]

[2] Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK. |Decreased central mu-opioid receptor availability in fibromyalgia. | J Neurosci. |2007 Sep 12;27(37):10000-6.

[3] [No authors listed] | Now we know: why opioids don’t work against fibromyalgia pain. Recent study reveals reduced opioid receptor availability in the brain; but a new FDA-approved drug brings relief. | Duke Med Health News. | 2008 Jan;14(1):3.

[4] Ross RL, Jones KD, Bennett RM, Ward RL, Druker BJ, Wood LJ. | Preliminary Evidence of Increased Pain and Elevated Cytokines in Fibromyalgia Patients with Defective Growth Hormone Response to Exercise. | Open Immunol J. | 2010;3:9-18.

[5] Broderick G, Fuite J, Kreitz A, Vernon SD, Klimas N, Fletcher MA. | A formal analysis of cytokine networks in chronic fatigue syndrome. | Brain Behav Immun. |2010 Oct;24(7):1209-17. Epub 2010 May 4.

[6] Nakamura T, Schwander SK, Donnelly R, Ortega F, Togo F, Broderick G, Yamamoto Y, Cherniack NS, Rapoport D, Natelson BH. | Cytokines across the night in chronic fatigue syndrome with and without fibromyalgia. | Clin Vaccine Immunol. | 2010 Apr;17(4):582-7. Epub 2010 Feb 24.

[7] Gur A, Oktayoglu P. | Status of immune mediators in fibromyalgia. | Curr Pain Headache Rep. | 2008 Jun;12(3):175-81.

[8] Ross RL, Jones KD, Bennett RM, Ward RL, Druker BJ, Wood LJ. | Preliminary Evidence of Increased Pain and Elevated Cytokines in Fibromyalgia Patients with Defective Growth Hormone Response to Exercise. | Open Immunol J. | 2010;3:9-18.

[9] Menzies V, Lyon DE. | Integrated review of the association of cytokines with fibromyalgia and fibromyalgia core symptoms. | Biol Res Nurs. | 2010 Apr;11(4):387-94. Epub 2009 Nov 22.

[10] Di Franco M, Iannuccelli C, Valesini G. | Neuroendocrine immunology of fibromyalgia. | Ann N Y Acad Sci. | 2010 Apr;1193:84-90.

[11] Di Franco M, Iannuccelli C, Valesini G. | Neuroendocrine immunology of fibromyalgia. | Ann N Y Acad Sci. | 2010 Apr;1193:84-90.