By: Dr Alex Robber
Patients who encounter fibromyalgia sometimes hear the words “You look so good. How could you get sick? “Or perhaps the words’ fibromyalgia’ are all in your brain.” Latest and continuing research, which validates the fact of this invisible disease. Such knowledge allows individuals with fibromyalgia and other related chronic disorders to move on and find support for their complex illnesses beyond doubt. More significantly, recognizing recent research helps give guidance and recognizes normal options with fibromyalgia for safe pain management.
What is inflammation?
Inflammation is a part of the process of healing the body. Without healing there would be no treatment for diseases and wounds. But inflammation can potentially be negative, too. There are two forms of, acute and chronic inflammation. Acute inflammation from an injury or infection comes on suddenly. It has classic symptoms including swelling, redness and pain.
Acute inflammation is momentary and lasts from a few days to a few weeks, depending on the cause of the inflammation. Chronic inflammation is an infection that lasts for months and years on end. Slowly it comes about and sets the stage for chronic illnesses. A chronic inflammation is associated with heart disease, autoimmune diseases, neurological diseases, diabetes, cancer, Alzheimer’s, arthritis and many other conditions.
Studies of PET imaging show elevated activation of the glia, associated with fatigue. For the first time a study has reported widespread inflammation in patients with the poorly understood condition called fibromyalgia in their brains.
A study by researchers at the Massachusetts General Hospital (MGH) — working with a team at the Karolinska Instituted in Sweden— has reported widespread inflammation in the brains of patients with the poorly understood condition called fibromyalgia for the first time. Their article in the journal Brain, Behavior and Immunity was published online.
“We do not have good treatment options for fibromyalgia, so identifying a potential target for treatment may lead to the development of new, more successful therapies,” says Marco Loggia, PhD, of the MGH-based Martinos Center for Biomedical Imaging, co-senior author of the report. “And discovering concrete neurochemical changes in the brains of fibromyalgia patients will help reduce the pervasive stigma that many patients face, sometimes telling them their symptoms are irrational and there’s nothing really wrong with them.
The present study provides evidence of elevated TSPO binding in patients with fibromyalgia (FM) relative to healthy controls (HC), as assessed with CPBR28 PET. This marker of glial activation was increased from previous neuroimaging research in several brain regions that were involved in FM pathology. In several of these areas, we also note positive associations between the TSPO PET signal and subjective fatigue scores, one of the most common symptoms identified by FM patients (Clauw, 2014, Wolfe et al., 2011). Our findings support a role in FM-pathology for neuroimmune / glial activation.
These results are consistent with a set of clinical data which indicate a possible association between neuroinflammation and FM. Several FM patients’ studies have shown elevated CSF levels of the molecules involved in neuroglial signals, such as fractalkine and IL-8. You can read the full research paper from here.
Fibromyalgia and Neuroinflammation
Inflammation in fibromyalgia has become an ever more important topic. In fibromyalgia (and other chronic pain disorders) there is “central sensitization”–an improvement in pain intensity engineered by the central nervous system. The inflammatory cycle releases pro-inflammatory nerve factors, such nerve factors send the pain-producing nerves into a tizzy and may be the source of that central sensitization.
Then, neuroinflammation is a big possibility in FM but it wasn’t easy to measure. It is only recently that brain imaging techniques have been developed that could calculate the neuroinflammation present in FM. This research tried to get in a different way on the issue of neuroinflammation. Recently there has been increased interest in the different brain cells that play a role in inflammation and hypersensitivity.
Microglia is one such cell considered to play a central role in the inflammatory brain responses. We have quite a dense population in the brain. But before we look more into the role of microglia in inflammation of the brain and hyper-reaction, let us understand more about inflammation and the relationship between inflammatory brain and peripheral diseases. After all, a health disorder that affects the peripheral organs is usually initiated by FM.
Mechanism of inflammation
Inflammation is system of defense. Once the body faces some infectious agent or local damage, the cells called macrophages identify it and essentially eat it up (infectious agent, waste, other foreign material). Macrophages also play a key role in triggering an immune response, and they secrete cytokines and chemokines to do so.
Chemokines are the messengers attracting other forms of defensive cells to the area, while cytokines are more complex messengers transmitting the stress information and attacking specific cells and parts of the body. Sickness occurs shortly after the initial inflammatory reaction, resulting in elevated body temperature, discomfort, and loss of interest in everything around.
It’s a moment when our brain centers are getting into practice. It is the specific brain centers that raise the body temperature so that microbial growth can be managed (increase in body temperature is regulated defensive mechanism). Our brain is trying to conserve energy by pushing us to relax, lower social contact, physical activity.
We know that regardless of where the inflammatory response is located, the brain plays a central role in coordinating the different responses. It raises the question of the mechanism that underlies the exchange of information between the point of inflammation (which can often be far from the brain) and the brain. This occurs in two ways: first, through the messengers called cytokines, and second, through the nerve inputs
Treatment to lower neuroinflammation
We already have some proof that treatments that can decrease symptoms of fibromyalgia by particularly lowering inflammation levels in the brain. Much of what we think of as anti-inflammatory medications (such as ibuprofen or other non-steroidal anti-inflammatory drugs) doesn’t function well on inflammation of the brain, but some treatments do. Low-dose naltrexone (LDN) is the most effective, which is a drug but mostly used by alternative medicine practitioners since most Western medicine physicians are not well known for its pain use.
The opiate-blocking drug is known as Naltrexone, which is administered in higher doses (50 mg) to treat dependency on opiate and alcohol. LDN reduces inflammation in the central nervous system when ingested at very small doses (dose range 1–5mg).
The immune cells in the brain have unique receptors called glial cells, LDN works on them and advises them to go back into hibernation and stop releasing inflammatory chemicals. LDN has been shown to significantly reduce fibromyalgia pain in two studies at Stanford University, as well as decrease pain hypersensitivity.
Herbal treatment to treat inflammation
Turmeric: For hundreds of years this yellow spice has been used as an anti-inflammatory in ayurvedic medicine. The active constituent is a chemical called curcumin, which research has shown to have anti-inflammatory effects in the brain.
Green tea: A chemical called EGCG (-)-epigallocatechin-3-gallate is shown to be “strongly defensive against inflammation, oxidative damage, and cell death” in the brain. It is extracted from green tea.
Cruciferous vegetables: Sulforaphane is an extract from broccoli and it protects against brain inflammation and decreases injury to neurons.
Anti-inflammatory supplements include:
- omega-3 fatty acids
- rhodiola rosea
Regarding inflammatory disorders, many doctors recommend anti-inflammatory diet, but we don’t have enough data on it. Individuals often start with strictly limited diet, because the inflammatory triggers of everybody are not the same, then add back to one form of food at a time to check which food is problematic.
Massachusetts General Hospital. “Research teams find widespread inflammation in the brains of fibromyalgia patients: PET imaging studies reveal elevated glial activation, correlation with fatigue levels.” ScienceDaily. ScienceDaily, 27 September 2018.
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- The Role of Neurogenic Inflammation in Fibromyalgia Pathophysiology by Cindy Lampner, MSLIS via Rheumatology Advisor
- Chiu IM, von Hehn CA, Woolf CJ. Neurogenic inflammation – the peripheral nervous system’s role in host defense and immunopathology. Nat Neurosci. 2012;15:1063-1067.
- Littlejohn G, Guymer E. Neurogenic inflammation in fibromyalgia. Semin Immunopathol. 2018;40:291-300.