Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain

Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain

By Ginevra Liptan, MD

Scientists have long suspected that inflammation in the brain (neuroinflammation) could be the cause of the amplification of pain signals in the brain seen in fibromyalgia. They can show this to be the case in lab animals, but this theory has been hard to prove in humans—mostly because researchers can’t very easily biopsy brain tissue of living people!

Ginevra Liptan, MD

However, some very creative Swedish scientists figured out a different way assess levels of inflammation in the brain, by sampling the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. Because the CSF is in constant contact with the brain, it mirrors what is happening in the brain.

Imagine pouring milk over a chocolate flavored puffed rice breakfast cereal. Slowly the milk will become brown and sweeter as it is absorbing the chocolate powder and sugars from the cereal. Rather than drinking the milk, if you instead sent a sample to a lab you would find small amounts of the ingredients of the cereal.

This is the same principle the Swedish researchers used in sampling the CSF in fibromyalgia: any inflammatory chemicals in the “brain juice” must have gotten there by being absorbed from the brain tissue. And what they found was that the CSF in fibromyalgia subjects contained much higher levels of inflammation compared to healthy people. In particular, there were very high levels of certain chemicals secreted by neurons (brain and nerve cells) in response to injury.

Lots of different animal research has shown that inflammation in and around neurons seems to be the key factor in the transition from acute pain to chronic pain, and in the development of the pain amplification seen in illnesses like fibromyalgia.  This study not only confirms that this process is happening in people with fibromyalgia, it also provides a new way to think about lowering fibromyalgia pain.

Treatments to Lower Neuroinflammation

We already have some evidence that treatments that specifically lower inflammation levels in the brain can lessen fibromyalgia symptoms. Many of what we think of as anti-inflammatory medications (like ibuprofen or other non-steroidal anti-inflammatories) don’t work well on brain inflammation, but there are some treatments that do. The most effective one is called low-dose naltrexone (LDN), which is a medication but primarily prescribed by alternative medicine providers as most western medicine doctors are not familiar with its use for pain.

Naltrexone is an opiate-blocking medication that is prescribed in higher doses (50mg) to treat opiate and alcohol addiction. But when taken at very low doses (1–5mg dosage range) LDN lowers inflammation in the central nervous system. LDN acts on specific receptors on the immune cells in the brain called glial cells, and tells them to go back into hibernation and stop releasing inflammatory chemicals. This allows the nerve cells to normalize the volume on pain. LDN was shown to significantly reduce fibromyalgia pain in two studies done at Stanford University, and also lessened pain hypersensivity.

Clinically I have found this treatment to be very effective in about 60% of the patients I prescribe it for, the biggest challenge is that it doesn’t combine very well with opiate-based pain medications. Learn more about LDN on my blog and my recent podcast interview with LDN Research Trust.

There are also some supplements derived from foods that may be able to calm brain inflammation including:

  • Turmeric: This yellow spice has been used as an anti-inflammatory in ayurvedic medicine for hundreds of years. The active ingredient is a chemical called curcumin which research has shown to have anti-inflammatory effects in the brain. https://www.ncbi.nlm.nih.gov/m/pubmed/19445907/
  • Green tea: A chemical called EGCG (-)-epigallocatechin-3-gallate, extracted from green tea, has shown been shown to be “strongly protective against inflammation, oxidative damage, and cell death” in the brain. https://www.ncbi.nlm.nih.gov/m/pubmed/21499987/
  • Cruciferous vegetables: An extract from broccoli called sulforaphane protects again brain inflammation and lessens injury to neurons. https://www.ncbi.nlm.nih.gov/m/pubmed/20417626/

Finally, a newer option that is not quite “medical” yet, but is now being heavily studied is cannabis (medical marijuana). Some of the active ingredients in marijuana can reduce neuroinflammation. One of the major psychoactive components of cannabis is called cannabidiol (CBD), and Brazilian researchers found it reduced neuroinflammation in mice. https://www.ncbi.nlm.nih.gov/m/pubmed/27889412/

This is good news for those who live where the whole plant marijuana is not yet legal as medicine, as some of those states will allow access to CBD-only options that are derived from hemp. The laws around medical marijuana and CBD are constantly changing, so I recommend you visit the Marijuana Policy Project site to get up to date information on laws in your state.

Other studies have focused on combination of THC (the psychoactive component of marijuana responsible for the “high”) along with CBD. Spanish researchers used a toxin to produce brain inflammation in rats. Afterwards, the rats that received a combination of THC and CBD extract showed less inflammation and damage in their brains. https://www.ncbi.nlm.nih.gov/pubmed/?term=22860209

Down the road treating the neuroinflammation in fibromyalgia may be a mainstay of treatment options. But, for now, at least we have some good options from the world of alternative and natural medicine to pursue.

Ginevra Liptan, MD, developed fibromyalgia while in medical school. She is a graduate of Tufts University School of Medicine and board-certified in internal medicine. Dr. Liptan is the founder and medical director of The Frida Center for Fibromyalgia and the author of The FibroManual: A Complete Fibromyalgia Treatment Guide For You…And Your Doctor.

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Authored by: Ginevra Liptan, MD

There are 5 comments for this article
  1. Jackie Ocheltree at 11:33 am

    I have Dermatomyositis and Polymyositis. There are many individuals in my support group who are using LDN and it is helping. I am having a difficult time finding a doctor who will prescribe it, in my area (I live in Chesapeake, VA). I don’t really want to do a video conference with a doctor, I like the “in person” appointment. I have only just learned about LDN within the past few months. I do have an appointment with my pain management doctor in 2 days and I will hopefully get them to prescribe. But I am not hopeful 🙁

  2. Barbara WAITT at 6:47 am

    Fascinating! Thanks Dr. I am thinking of using LDN but, I have to get off opiates 1st. But, I use all of the other alternatives mentioned

  3. Robert Schubring at 11:13 am

    Ignorant people at the DEA attacked the prescribing of low-dose naltrexone with opioids, believing that the purpose of the naltrexone was to block some of the effect of the opioids, thereby forcing the patients to require more opioids. Unfortunately, when they prosecuted Dr William Hurwitz on this silly theory, they refused to allow him to present a defense, and he was wrongfully convicted. It took an appeal and a retrial, to establish that this treatment methodology was based on real facts.

    Thankfully, Stanford researchers continued studying how the therapy works.

  4. claudine gallien at 9:09 am

    I got dissy spell constantly. Doc put me on Betahistine 16mg ea. Start at half a pill a day every 8 hrs. Didn,t work. Now she increas to 1 every day 16 mg every 8 hrs. But it don,t work either. Still waiting for test for inner ears , but take forever to get it . It is very dangerous for cause there no warning when it happen etc. Fell many time etc. It interfere with my daily life .What is the cause of that? Better med ? When it happen i got nausea and don,t feel to eat at all.Please can you give me any ideas.Thank you very much.

  5. Cayce at 7:32 am

    I think this is something that has been hypothesized for a while & I am glad that they are finally making progress in terms of uncovering real scientific data to back this up. I am ready to take bottle of Advil and cram it somewhere on my doctors body that it 1) doesn’t belong 2) will hurt when I’m done.
    I am also supportive of positive legislation on cannabis, as I believe that it helps a good cross-section of people, possibly not to the extent that their painkillers once did, but those days are clearly over. I am aware that cannabis is not for everyone & we need to make strides in formulating more ways to ease FMS pain for more people, in a cost-efficient, convenient, and low side effect way that has high results. This is a great step in that direction.
    And I feel that we were working toward that goal, until this: http://www.npr.org/2017/04/06/522821701/legal-marijuana-advocates-are-uneasy-with-sessions-stance
    So put away your angry letters regarding opioids, they’re never coming back, and pick up your pen and tell the new and oh so popular and enlightened administration how you feel about Them now playing doctor and judging your pain relief methods.
    Btw, Jared Kushner, POTUS SIL, is currently in charge of the national “opioid crisis”. Send him your letters. When he gets back from being Desert Stom Ken doll, maybe he’ll read them.
    Good luck! And may all of our greater powers and continuum of nothingness help us, because we actively need all the help we can get.

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