Is There a Role for Cytokine Based Therapies in Fibromyalgia

Abstract

The etiology of fibromyalgia syndrome (FM) is uncertain and the prognosis for symptomatic recovery is generally poor. A wide variety of interventions are used in the management of FM. There is, however, no clear consensus on the treatment of choice and FM remains relatively refractory to treatment. Therefore, prevention, causal therapy and rehabilitation are not possible. FM patients frequently use alternative therapies, indicating dissatisfaction or ineffectiveness of traditional medical therapy. Alternative therapies are generally perceived to be more "natural" and as a result, to have fewer adverse effects. Despite the positive results found, the number of publications related to the application of physical therapy modalities such as acupuncture, transcutaneous electrical stimulation, laser, biofeedback, electrotherapy and magnetic field is still scant, especially concerning FM treatment. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed. Multidisciplinary approaches to management include physical and medical therapeutic strategies. Treatment modalities should be individualised for patients based on target symptoms and impairment in functioning. Patience and positive attitude on part of the physician and active involvement of patients and their families in treatment are likely to enhance improvement. It can be concluded that there is a need for larger, more systematic and methodologically sound randomised controlled clinical trials to evaluate the effectiveness of physical therapy modalities of managing FM. We will review some of the existing studies of physical therapy relevant in the treatment of FM and give some practical advice for their use.

Evidence for Inflammation in the Fibromyalgia Syndrome

“…The majority of the evidence for such an assertion comes from studies of abnormal cytokine levels in the serum or in vitro cultures of leukocytes from patients with FMS compared with samples taken from healthy normal controls (1)(2)(3)(4)(5)(6)(7)(8)(9). This topic was recently reviewed (10).…”

The Role of Oxidative Stress and Mitochondrial Dysfunction in the Pathogenesis of Fibromyalgia

“…Increased levels of Inflammatory mediators such as tumor necrosis factor alpha (TNF-) and interleukins, have been associated with mitochondrial dysfunction and increased ROS generation (Naik & Dixit, 2011), and it has been hypothesized that abnormal production of cytokines may play a role in the pathogenesis of FM (Wallace et al, 2001). IL-1, IL-6 and IL-8 are dysregulated in the syndrome and therapies directed against these cytokines may be of potential importance in the management of fibromyalgia (Wallace, 2006). However, different studies with conflicting results (Uçeyler et al, 2006;Bazzichi et al, 2007) make necessary more studies to better understand the role of cytokines in FM.…”

Review of the mechanisms involved in a complex pain syndrome: fibromyalgia

“…Parmi ces facteurs, les interleukines 1, 2, 6, 8, 10 (IL-1, IL-2, IL-6, IL-8, IL-10) ainsi que le facteur alpha de nécrose tumorale (TNF-alpha) semblent présenter des niveaux plus élevés dans le sérum des fibromyalgiques [15,63,177]. Ces observations sont intéressantes puisque l'IL-6 a été associée à des états hyperalgésiques, de la fatigue et de la dépression, tandis que l'IL-8 stimule la douleur induite par le système nerveux sympathique [177]. La participation de ces facteurs donnerait raison à Omoigui pour qui toute douleur implique une composante inflammatoire [131].…”