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!
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.