Fibromyalgia symptoms – severity related to cytokine levels

Some pro-inflammatory cytokines elevated in fibromyalgia; correlation with pain intensity

This is an important publication because it clearly demonstrates that fibromyalgia is a disease of inflammation and that symptomatic relief can be achieved through the reduction of inflammation.

Higher than normal levels of pro-inflammatory cytokines in the blood indicate ongoing inflammation. When inflammation is relieved, as demonstrated by a reduction in those pro-inflammatory cytokines, symptoms improve – pain decreases.

Results of the investigation

Initial findings in fibromyalgia patients:

IL-8 levels are high

TNF levels are high

IL-6 levels are normal

IL-4 levels are normal

IL-10 levels are normal (IL-10 is an anti-inflammatory cytokine)

Once treatment begins:

TNF levels drop quickly, by 10 days, and remain low through 6 months after treatment.

IL-8 is substantially decreased by six months.

Pain correlation:

Pain reduction does not correlate with TNF levels.

Pain reduction does correlate with IL-8 levels.

The authors conclude that pro-inflammatory cytokines TNF and IL-8 are involved in FM, but that they most likely do not directly cause the pain of fibromyalgia.

Nonetheless, IL-8 may be very closely associated with pain, because the  pain decreases when levels of IL-8 decrease.

IL-8 is frequently associated with inflammation. An excess of IL-8 has been demonstrated in certain cancers, inflammatory bowel disease, psoriasis and other ailments. Its excess clearly demonstrates an ongoing inflammatory condition.

The publication:

July, 2008

Circulating cytokine levels compared to pain in patients with fibromyalgia — a prospective longitudinal study over 6 months.

Summary of the abstract

OBJECTIVE: This prospective study examined circulating cytokines in patients with fibromyalgia (FM) over 6 months rather than at only one time point, and investigated correlations between serum cytokine concentrations and pain intensity in FM patients receiving multidisciplinary pain therapy.

RESULTS: On admission, serum levels of IL-8 and TNF-alpha, but not IL-6, were elevated in patients with FM.

No significant difference in IL-4 and IL-10 was found between FM patients and controls. High IL-8 levels remained consistent during the followup, but TNF-alpha was already reduced after 10 days and until 6 months after therapy.

After 6 months’ treatment with multidisciplinary pain therapy, IL-8 and TNF-alpha levels were significantly lower than at the beginning.

IL-8 but not TNF-alpha serum levels were correlated with pain intensity in FM patients after 6 months’ multidisciplinary pain therapy.

CONCLUSION: Our results suggest that pro-inflammatory cytokines TNF-alpha and IL-8 are involved in FM, but they do not apparently provoke the pain of FM directly. Multidisciplinary pain therapy modified the cytokine profile in patients with FM during the observation period.

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