New treatments for fibromyalgia are based on research into the role of inflammatory cytokines in the mechanism of pain production. Most of us are familiar with the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen to treat headaches and other minor pain conditions. More powerful anti-inflammatory drugs, the corticosteroids, are now being considered for chronic pain conditions including fibromyalgia. In addition, intravenous immunoglobulin and ultraviolet light have been tested for fibromyalgia pain, with promising results.
While the NSAIDs target the production of one type of inflammatory chemical, the corticosteroids reduce the production of several inflammatory chemicals and modify the function of white blood cells. They can either increase or decrease the perception of pain. This type of action is called a paradoxical effect. A recent report from The Rockefeller University suggested that corticosteroid treatment may be developed as a first line therapy for pain management.
Intravenous immunoglobulin (IVIg) was commercialized in the early 1980's as a treatment for immune deficiencies. It is produced from the plasma of a large number of healthy blood donors (similar to the clotting factor used for hemophilia). It is now used for a large number of autoimmune and systemic inflammatory conditions. This seems paradoxical as well, since we generally view immune deficiencies as “too little”, and autoimmune conditions as “too much” of the normal immune response. IVIg is even used for some transplant patients, who require powerful immune suppression, and for some patients with sepsis. A recent review article reported evidence that IVIg may be effective at reducing pain in chronic pain syndromes as well.
A very different immune-modulating treatment is ultraviolet light from tanning beds. A study from the Wake Forest School of Medicine in North Carolina showed reduced pain levels plus improvements in positive affect, well-being, and relaxation from six weeks of UV light. The subjects exposed to UV light had better scores than control subjects exposed to non-UV light.