Fibromyalgia is the “current term for chronic widespread musculoskeletal pain for which no alternative cause can be identified”. Typical symptoms includes chronic widespread pain, paresthesias, allodynia, fatigue, sleep difficulties and cognitive impairment.
It appears that both neuroendocrine and immune dysfunctions contribute to the pathophysiology of FM. This includes sympathetic dysautonomia characterized by relentless sympathetic hyperactivity accompanied by sympathetic nervous system hypo-reactivity to different stressors. The inflammatory/immune component is characterized by the involvement of cytokines and chemokines such as IL-8 and IL-17.
In the Journal of Pain Research study, Emmanuel Bäckryd and colleagues from the Pain and Rehabilitation Center, Linköping University, Sweden applied the multiplex proximity extension assay (PEA) in which 92 proteins were simultaneously analyzed in cerebrospinal fluid (CSF) and plasma samples from 40 FM patients.
The authors found elevated IL-8 levels in both CSF and plasma FM samples, confirming previous reports, whereas high levels of CX3CL1 were monitored only in CSF samples. As per the authors, this may indicate the presence of both neuroinflammation and chronic systemic inflammation in FM.
Regarding the question of causality, the authors discuss and hypothesize 3 major scenarios: 1) their results reflect the involvement of these chemokines in the pathophysiology of FM; 2) they reflect a risk factor present prior to the development of chronic pain, and 3) they may indicate just a consequence of the chronic pain condition, and “mirroring pain-related stress, inactivity, depression or bad sleep”.
It is known that the CX3CL1/ fractalkine is “found commonly throughout the brain, particularly in neural cells, and its receptor is known to be present on microglial cells”, whereas “IL-8 is the first endogenous mediator to be identified as evoking hyperalgesia involving the sympathetic nervous system”.
Of note, Kathleen Sluka and Daniel Clauw recently stated that “fibromyalgia and related disorders are heterogenous conditions, with patients falling along a continuum with one end a purely peripherally driven painful condition and the other end of the continuum is when pain is purely centrally driven”.
Thus, it is interesting whether future studies may identify a stratification of FM patients in terms of CX3CL1 and IL-8 levels.
Source: J Pain Res, 2017; 10: 515–525.
Read more: Journal of Pain Research
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