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. UV light has previously been shown to reduce inflammation in other conditions.
References:
1. Di Franco M et al, “Neuroendocrine immunology of fibromyalgia”, Ann N Y Acad Sci. 2010 Apr; 1193: 84-90.
2. McEwen BS et al, “The role of corticosteroids and stress in chronic pain conditions”, Metabolism. 2010 Oct; 59 Suppl 1: S9-15.
3. Goebel A, “Immunoglobulin responsive chronic pain”, J Clin Immunol. 2010 May; 30 Suppl 1: S103-8.
4. Hartung HP et al, “Clinical applications of intravenous immunoglobulins (IVIg) beyond immunodeficiencies and neurology”, Clin Exp Immunol. 2009 Dec; 158 Suppl 1: 23-33.
5. Taylor SL et al, “Pilot study of the effect of ultraviolet light on pain and mood in fibromyalgia syndrome”, J Altern Complement Med. 2009 Jan; 15(1): 15-23.
6. More information on corticosteroids:
http://my.clevelandclinic.org/drugs/corticosteroids/hic_corticosteroids.aspx
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.