FibromyalgiaTreatment

Cytokines are dysregulated in fibromyalgia and are likely the cause of pain suffered by those with fibromyalgia.

Cytokines are glycoproteins that serve as chemical messengers between cells. They assist in the regulation of cell growth and repair and also have immune modulating properties. Cytokines play a role in diverse clinical processes and phenomena such as fatigue, fever, sleep, pain, stress and aching.

A review of the fibromyalgia literature and related studies suggest that IL-1, IL-6 and IL-8 are dysregulated in the syndrome. Therapies directed against these cytokines may be of potential importance in the management of fibromyalgia1.

A study in the United Arab Emirates found a beneficial effect of vitamin D treatment for those diagnosed with fibromyalgia or muscle pain:

The aim of our study was to determine the prevalence of vitamin D deficiency (<20 ng/dl) among patients with fibromyalgia or muscle pain in a musculoskeletal clinic in the United Arab Emirates. Consecutive patients who were diagnosed with fibromyalgia and/or non-specific musculoskeletal pain (ICD-9 729.1) were screened for vitamin D deficiency. Patients were seen at follow-up after treatment with vitamin D was given. Improvement was assessed by a simple questionnaire. Patients (139) with muscle pain were seen in 2007. Average age was 40 +/- year; 95% were female; 69 (49%) were Arab, of whom 92% were veiled; 43 (30%) Indian of whom 11% were veiled; 23 (16%) were Caucasian; and four were East Asian (3%) and all wore western clothes. One hundred three (74%) of these patients had a low vitamin D level. Vitamin D deficiency was most common among Arab patients (86%) and Indo-Pakistani (87%) and least common among the Caucasians (8%) and was equally prevalent among veiled and non-veiled patients. Treatment resulted in clinical improvement in 90% of patients. Non-specific muscle pains among Arab and Indian-Pakistani populations may indicate vitamin D deficiency, and prompt treatment can result in resolution of symptoms2.

A randomized controlled trial using 7,000 IU/day of vitamin D3 for eight weeks found a significant benefit for those with fibromyalgia:

OBJECTIVE: To examine the association of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment in a randomized, double-blind, placebo-controlled trial.
METHODS: Adult primary care patients in Duluth, Minnesota, were screened for vitamin D deficiency in February 2007. Participants completed questionnaires pertaining to a variety of symptoms, vitamin D intake, and selected medical conditions. Patients with mild to moderate vitamin D deficiency (25-hydroxyvitamin D [25(OH)D], 10-25 ng/mL) participated in a randomized controlled trial (RCT) of vitamin D replacement and its effect on symptoms. Participants were randomly assigned to receive 50 000 units of cholecalciferol (vitamin D3) weekly or placebo for 8 weeks. Patients with severe vitamin D deficiency (25[OH]D <10 ng/mL) were treated in an unblinded fashion, and symptoms were reevaluated post treatment.
RESULTS: A total of 610 patients underwent initial screening, and 100 patients with mild to moderate vitamin D deficiency participated in the RCT. Thirty-eight severely deficient patients were treated in an unblinded fashion. On initial screening, 46.2% of participants were deficient in vitamin D. Self-reported vitamin D supplementation, milk intake, celiac disease, gastric bypass, and chronic pancreatitis were predictive of vitamin D status. Severely deficient participants reported increased musculoskeletal symptoms, depression (including seasonal), and higher (worse) scores on a fibromyalgia assessment questionnaire. In the RCT, the treated group showed significant improvement in fibromyalgia assessment scores (P = 0.03), whereas the placebo-treated participants did not. Severely deficient patients did not show symptom improvement over the 8-week trial period or when followed up 1 year later.
CONCLUSIONS: Compared with participants in the placebo group, patients in the treatment group showed mild short-term improvement in the overall fibromyalgia impact score, but did not show significant improvement in most musculoskeletal symptoms or in activities of daily living3.

Diffuse back pain related to vitamin D deficiency is often diagnosed as fibromyalgia4. Raising serum 25(OH)D levels reduces that type of pain54. It also helps strengthen muscles6.

It seems likely that it would reduce the pain associated with fibromyalgia. It would certainly reduce the risk of osteoporosis. Those with fibromyalgia should consider keeping serum 25(OH)D levels above 30-40 ng/ml (75-100 nmol/l).

Page last edited: 17 May 2011

References

  1. Wallace, D. J. Is there a role for cytokine based therapies in fibromyalgia. Curr Pharm Des. 2006; 12 (1): 17-22.
  2. Badsha, H. Daher, M. Ooi Kong, K. Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency. Clin Rheumatol. 2009 Aug; 28 (8): 971-3.
  3. Arvold, D. S. Odean, M. J. Dornfeld, M. P. Regal, R. R. Arvold, J. G. Karwoski, G. C. Mast, D. J. Sanford, P. B. Sjoberg, R. J. Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial. Endocr Pract. 2009 Apr; 15 (3): 203-12.
  4. Erkal, M. Z. Wilde, J. Bilgin, Y. Akinci, A. Demir, E. Bodeker, R. H. Mann, M. Bretzel, R. G. Stracke, H. Holick, M. F. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int. 2006; 17 (8): 1133-40.
  5. Plotnikoff, G. A. Quigley, J. M. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec; 78 (12): 1463-70.
  6. Holick, M. F. Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging. 2007; 24 (12): 1017-29.