Category: Research

Evidence for New Fibro Drug Therapies: Options to Take to Your Doctor if Your Current Treatments aren’t Working

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Evidence for New Fibro Drug Therapies: Options to Take to Your Doctor if You Current Treatments aren't Working

New research into drug therapies helps people with fibromyalgia increase their treatment options. Learning about these new medication options can help you and your doctor you find the best treatment regimen for you.

If you live with fibromyalgia, you know firsthand that one of the primary features of this condition is a lower pain threshold compared to healthy people. There are a number of changes in the body caused by fibromyalgia that increase our sensitivity to pain. One set of changes affect how the spinal cord relays pain sensations from the body to the brain. Several drugs target specific receptors, called NMDA receptors, which are located in deep spinal neurons that carry sensory information to regions in the brain that relate to pain processing. NMDA receptors are activated by signals relayed to the spinal cord by peripheral neurons that sense pressure in muscles, tendons, etc. This type of receptor is activated by the neurotransmitter glutamate. Studies have shown elevated levels of glutamate in the brain and spinal cord of patients with fibromyalgia.[i] There is a strong correlation between elevated glutamate and increased pain in people with fibromyalgia. NMDA receptors can amplify pain signals in patients with fibromyalgia because they are activated to a greater degree by the presence of increased glutamate concentrations in the brain/spinal cord, which trigger pain signals sent to the brain by the deep spinal neurons.

NMDA receptors can be prevented from firing by certain compounds. Two drugs in particular seem effective at decreasing NDMDA receptor activation. One is called memantine. Memantine blocks NMDA receptors and decreases glutamate levels. “A randomised, double-blind study in 63 patients with fibromyalgia compared memantine… with placebo over a 6-month period. Compared to placebo there was a significant reduction in pain and pain threshold and improvement in global function, mood and quality of life”.[ii] Memantine was originally developed to treat diabetes, but has also been used to treat dementia; it has been found to also be effective in treating chronic regional pain syndrome.

Ketamine is another potent NMDA receptor blocker (yes, the illegal party drug). Studies have shown that it can effectively reduce pain for a subset of fibromyalgia patients “Thus, of 58 patients with fibromyalgia in the above 3 studies, 33 (57%) responded to low dose ketamine (0.3mg / kg) infusion, as defined by a reduction of pain by 50% or more.”[iii] However, studies have not adequately investigated long term use of ketamine. However, ketamine has been proven effective in treating chronic regional pain syndrome, which shares many similar characteristics to fibromyalgia.

Another interesting tip focuses on diet changes that can help lower pain levels. Glutamate is found in MSG (monosodium glutamate). Other related compounds, called excitotoxins, like aspartame, can cause harmful over-activity in the brain. “One study showed that 4 weeks of exclusion of monosodium glutamate (MSG), aspartame, and other excitotoxins, resulted in over 30% improvement in fibromyalgia symptoms in 84% of those who completed the diet”.[iv]

What about inflammation and fibromyalgia? A number of studies have found increased levels of pro-inflammatory messengers (called cytokines) in blood collected from FM patients.[v]  A drug called low-dose naltrexone has been investigated for its potential benefits in treating fibromyalgia because of its anti-inflammatory properties.[vi] Naltrexone is primarily used to treat opioid overdoses, but when taken at a low dose before bed, studies have found a statistically significant reduction in FM pain compared to the placebo. A recent study found that “after eight weeks of LDN administration, plasma levels of a range of broadly pro-inflammatory cytokines were decreased. In addition, we found that participants reported less pain and symptoms following LDN. Combined, these results support the hypothesis that LDN may help chronic pain conditions, such as fibromyalgia, by acting as an atypical anti-inflammatory medication”.[vii] Pain reduction was found to be 15% and symptom reduction 18%. While these results are modest, for many FM patients desperate for options, low-dose naltrexone could be a valuable part of their treatment regimen.

Evidence for New Fibro Drug Therapies: Options to Take to Your Doctor if You Current Treatments aren't Working

Works Cited

Littlejohn, G., & Guymer, E. (2017). Modulation of NMDA Receptor Activity in Fibromyalgia. Biomedicines 5 (5), 15-27.

Parkitny, L., & Younger, J. (2017). Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. Biomedicines 5 (2), 16.

Ross, R., Jones, K., Bennett, R., Ward, R., Druker, B., & Wood, L. (2010). Preliminary Evidence of Increased Pain and Elevated Cytokines in Fibromyalgia Patients with Defective Growth Hormone Response to Exercise. Open Immunol J, 3, 9-18.

Citations

[i] (Littlejohn & Guymer, 2017)

[ii] (Littlejohn & Guymer, 2017)

[iii] (Littlejohn & Guymer, 2017)

[iv] (Littlejohn & Guymer, 2017)

[v] (Ross, Jones, Bennett, Ward, Druker, & Wood, 2010)

[vi] (Parkitny & Younger, 2017)

[vii] (Parkitny & Younger, 2017)

Could a Treatment for Herpes also be Effective for Treating Fibromyalgia?

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Could a treatment for herpes also be effective for treating fibromyalgia?A recent study investigated whether it would be effective to  treat fibromyalgia patients with an anti-viral and anti-inflammatory drug combination that is normally used to treat the herpes virus (cold sores or genital herpes). The anti-viral drug used in this study also treats the shingles virus (which additionally causes chickenpox). Specifically, researchers tested a famciclovir + celecoxib drug combination called IMC-1. The study was based on the hypothesis that life stressors could re-activate latent viral infections  (viral infections from earlier in life that become dormant), which in turn cause fibromyalgia to develop. This hypothesis is based on anecdotal evidence of patients who develop fibromyalgia after experiencing infections and/or periods of stress. Does that sound familiar?

The results of this double-blind, placebo-controlled study were positive: participants receiving the anti-virals had significantly less pain and fatigue compared to participants who received a placebo. Encouragingly, IMC-1 was well tolerated by study participants, with few side-effects. Researchers concluded that the effectiveness of the anti-viral drugs suggests that the herpes virus may play a role in the development of fibromyalgia for some patients. Interestingly, this conclusion was based on the efficacy of the drug rather than testing the study participants for the herpes virus. I wonder whether this line of investigation could be expanded to include other potential viral triggers.

This hypothesis resonates with me because in the months before I developed fibromyalgia, I had a mumps infection, which I always attributed as a trigger for the onset of my fibromyalgia. In addition, I have had shingles, which the anti-viral used in the study also treats. This is a fascinating new area of research that will hopefully provide more answers and solutions to the treatment of fibromyalgia. In the meantime, if you have the herpes virus (or other significant viral infection) and fibromyalgia, I recommend taking this study to your doctor to see if IMC-1 might be an effective option for you!

Reference:

Pridgen, W. et al. (2017). A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia. J. Pain Res., 10, 451-460. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328426/

New Study Identifies Brain Signature in 93% of FM Patients

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As most fibromyalgia patients know, there are no approved tests to diagnose this chronic pain condition. A new study has taken science a step forward in this direction. Researchers at the University of Colorado Boulder have identified a brain signature that is able to predict fibromyalgia with 93% accuracy. Functional MRI Scans were used to compare brain activity in 37 fibromyalgia patients and 35 healthy controls as they were exposed to multiple sensory sensations (visual, auditory and pressure).  The study found three ‘neurological patterns’ common to 93% of the participants with fibromyalgia. Specifically, these brain responses “show characteristically enhanced unpleasantness to painful and non-painful sensations accompanied by altered neural responses” (Lopez-Sola, et al., 2016). As this was the first neuro-imaging study of the chronic pain condition, it provided further proof that fibromyalgia is a central nervous system disorder. Additional studies may help to determine if there are sub-types of the condition and individual variations, ultimately leading to more effective treatments.

  • Marina López-Solà, Choong-Wan Woo, Jesus Pujol, Joan Deus, Ben J. Harrison, Jordi Monfort, Tor D. Wager.Towards a neurophysiological signature for fibromyalgia. PAIN, 2016; 1 DOI: 1097/j.pain.0000000000000707
  • University of Colorado at Boulder. (2016, October 17). Neural signature for fibromyalgia may aid diagnosis, treatment.ScienceDaily. Retrieved October 20, 2016 from sciencedaily.com/releases/2016/10/161017111159.htm

Self-Care for Chonic Illness: Research Round-up

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Research Roundup

Part of being a health nerd means enjoying reading research. As a health nerd and a blogger I figured I should start a series of the most interesting recent research on chronic conditions. Learning about self-care has been an important part of my health journey, as well as a source of enjoyment for my inner nerd. So here is the first installment of my Research Roundup series, organized by self-care skills – Lifestyle, Exercise,  Attitude, and Nutrition. I hope this encourages you to make self-care part of your health journey! #SelfCareMvmt

  • Lifestyle: A recent Australian study investigated the most effective strategies for improving sleep among an elite women’s basketball team. The results may help you prioritize which strategies to try if you suffer from insomnia or poor quality sleep. The most effective bedtime routines were: turning off all electronic devices at least an hour before bed (that includes your phone), practicing mindfulness or meditation, and sleeping in a cool environment. These strategies were found to improve sleep and performance on the court.
  • Exercise: A New York Times editorial recently argued that moving more, not weight loss, is the cause of the dramatic health benefits of exercise demonstrated in hundreds of research studies. From arthritis, to cardiovascular disease, to Parkinson’s, to chronic fatigue syndrome, to depression, a massive meta-analysis found that exercise improved health and well-being among all these chronic conditions. It’s no wonder that the Academy of Medical Roil Colleges calls exercise a ‘miracle cure’. But moving more, as the editorial pointed out, does not require shedding blood sweat and tears. Instead, researchers recommend 150 minutes of moderate exercise per week. This could involve walking your dog or walking laps around your living room, cycling at the gym or gardening at home, doing seated tai chi by following an instructional DVD or vacuuming your house.
  • Attitude: Forgiveness can protect your health from the negative effects of stress, according to a new study. Researchers assessed 148 participants in terms of stressful life experiences, mental and physical health, and their tendency to forgive. As expected, high levels of lifetime stress correlated with worse health outcomes. Unexpectedly, a high tendency towards forgiveness eliminated the negative impacts of stress on health. In other words, forgiveness of yourself and others acts as a buffer against stress, eliminating the connection between stress and mental or physical illness. Interestingly, forgiveness is a trait that can be cultivated. Prior research has demonstrated that briefly praying or meditating on forgiveness can increase your ability to be forgiving in close relationships.
  • Nutrition: A new study weighs in on the debate about whether eating grains is good for you. You may be familiar with the paleo diet. Its proponents argue that the human digestive system has not evolved beyond the hunter-gatherer diet. Grains, they argue, are a modern invention evolutionarily speaking, and wreak havoc in the human body, whether through causing inflammation or exacerbating autoimmune conditions. On the other side of the debate, researchers argue that grains provide necessary nutrients, fiber and energy. This study comes down on the latter side of the argument. An international team found that a higher consumption of whole grains correlated with a lower risk of chronic disease and premature death from all causes. Three servings of whole grains per day (90 g/day) was associated with a 22% reduction cardiovascular disease risk, 15% reduction of cancer risk and 51% reduction in diabetes risk. It is important to know that no benefits were associated with intake of refined/processed grains or from white rice. (If you are interested in how to differentiate whole grain from refined grain products, follow this link).

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Photo by Lukasz Zajac

Shared to Fibro Friday Link-up at the Fibro Blogger Directory and Chronic Friday Linkup

Vulva Monologues: Topical Gabapentin and Vulvodynia

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November 2010

I shudder when I remember that summer. I was so frustrated with my body. I couldn’t understand what was happening. Newly engaged, and we couldn’t be intimate. Every time we tried, it ended in tears. My partner tried to be strong for us, to be positive, but I wanted him to be vulnerable, to show me he hurt too. I tried crazy things, like inserting yogurt and even garlic in an attempt to get rid of what I guessed might be a horrible yeast infection gone wrong. That ended up with me going to an emergency room with cramps and irritation, and a look from the doctor like I was going to be one of her stories (“I had this crazy patient who…”).  Vulvodynia isn’t just a yeast infection, and don’t put garlic anywhere near your vulva – they aren’t friends!

After months of waiting, I finally saw an OB-GYN with expertise in vulvodynia. She confirmed my diagnosis of provoked vulvodynia (also called vulvar vestibulitis). Her first course of treatment was a topical compound cream of lidocaine and gabapentin.

A 2008 study of 35 women with local and general vulvodynia women treated with topical gabapentin found that 80% had a 50% reduction in vulvar pain (Boardman et al., 2008). The benefit of topical application is that you avoid the body-wide side effects of taking a pill. If you are interested in a topical treatment, another option is topical amitriptyline and baclofen (an anti-depressant and muscle relaxant, respectively). A small retrospective study  that investigated this treatment found :  29% patients reported no or little (<30%) improvement, 18% reported moderate (30-60%) improvement, and 53% reported much (>60%) improvement (Nyirjesy, 2009).

Unfortunately for me, after 3 months there was no change in my pain (and no sex either). I also felt that the base cream was even causing some irritation around the outer labia. So, the journey to find an effective treatment continued…

Topical gabapentin in the treatment of localized and generalized vulvodynia.
Obstet Gynecol. 2008 Sep;112(3):579-85.
Boardman LA, Cooper AS, Blais LR, Raker CA.

Topical Amitriptyline-Baclofen Cream for the Treatment of Provoked Vestibulodynia

Journal of Lower Genital Tract Disease:

October 2009 – Volume 13 – Issue 4 – pp 230-236

Nyirjesy, Paul MD1; Lev-Sagie, Ahinoam MD2; Mathew, Leny MS1; Culhane, Jennifer F. PhD1