Antioxidant status, lipid peroxidation and nitric oxide in fibromyalgia: etiologic and therapeutic concerns

Abstract

We proposed to assess the oxidant/antioxidant status, lipid peroxidation and nitric oxide (NO) in untreated fibromyalgia (FM) patients and controls. The effect of amitriptyline (A, 20 mg daily) and sertraline (S, 100 mg daily) treatment on patients' superoxide dismutase (SOD), xanthine oxidase (XO), adenosine deaminase (ADA) enzyme activities, thiobarbituric acid reactive substances (TBARS) and NO levels was investigated. Thirty female patients with primary FM and age-matched 16 healthy female controls were included. Patients received an 8-week course of treatment with either A or S. FM patients had higher serum levels of TBARS (particularly malondialdehyde) and lower levels of nitrite compared to controls whereas enzyme activities were similar. A and S significantly improved Fibromyalgia Impact Questionnaire (FIQ) pain scores, Hamilton anxiety and depression rating scales. But neither A nor S had significant effects on measured oxidative stress parameters, except SOD activity that was significantly reduced after S treatment. Total myalgic scores negatively correlated with XO activity, and depression scales negatively correlated with levels of TBARS. Our results indicate that patients with FM are under oxidative stress. These findings represent a rationale for further research assessing the effect of free radical scavengers or antioxidant agents like vitamins and omega-3 fatty acids on peripheral and central mechanisms in FM.

Fibromyalgia and nutrition, what do we know?

“…For instance, it has been observed that some FM patients had lower levels of some antioxidant nutrients like magnesium and selenium [15,16]. They also seem to have an insufficient antioxidant status [17], a predominance of a pro-oxidative status [18], and a lower antioxidant capacity [19]. The results indicate that these patients have a high level of oxidative stress and perhaps the high levels of free radicals in their bodies may be involved in the development of the disease.…”

Use of oxygen-ozone therapy in the treatment of fibromyalgia

“…12 More recently, there has been some evidence for the dysregulation of oxidative processes playing a role, in studies that have shown the plasma of FM patients contains increased levels of lipid peroxidation products (LP) and carboxylated proteins, the end result of both being membrane damage induced by ROS, 4,6,13 alongside a reduction in total antioxidant capacity or of antioxidant enzymes such as superoxide dismutase (SOD) and catalase. 4,6,13 Several experimental models have revealed an increase in the production -on several levels -of ROS and other harmful radicals, which go on to interact with cellular structures, resulting in the typical symptoms of FM. Oxidative stresses and ROS such as for example, NO seem therefore to be mainly involved in the pathogenesis of FM even if it is not yet known whether redox equilibrium alterations are a cause or effect of this pathology.…”

“…Oxidative stresses and ROS such as for example, NO seem therefore to be mainly involved in the pathogenesis of FM even if it is not yet known whether redox equilibrium alterations are a cause or effect of this pathology. 5,6 Studies to date have shown how various mechanisms come into play in the body. For example, the cause of H2O2 increases in the neutrophils of these patients, similar to an increase of superoxide of mitochondrial origin in the mononuclear cells of the peripheral blood, 4,14 can be explained by a CoQ10 deficiency in patients with FM.…”

“…3 Finally, in recent years, oxidative stress has assumed a leading role in the pathophysiology of FM 4 although it is not yet known whether its increase is a causative factor in the disease or a consequence of the patient's general condition. 5,6 In patients with FM, an increase in the concentrations of malonyldialdehyde have been found, alongside a low concentration of antioxidant enzymes like catalase, glutathione peroxidase and superoxide dismutase. 5,7 Ozone is known to exert a mild, transient and controlled oxidative stress that promotes upregulation of antioxidant systems and modulation of the immune system.…”

Adjuvant Use of Melatonin with Fluoxetine for Management of Fibromyalgia

“…Recent theory on the cause of FMS hypothesized that oxidative stress may play an important role in the disease. Mcclever et al (2006) found that women with FMS experienced a reduced flow of nutrient to the muscle after exercise, and this might be related to elevated levels of inducible nitric oxide synthase (iNOS) with consequent production of elevated level of nitric oxide [9,10]. Central sensitization associated with FMS may be caused by stimulation of pain receptors in muscle, which may occur due to inflammatory cytokines that trigger iNOS in the muscle with inappropriate stimulation of pain receptors, and an increase in the production of reactive oxygen species (ROS) such as the peroxynitrite radical and others reactive oxygen species [11,12].…”