Opioid Receptors Impaired in Fibromyalgia Patients

µ-Opioid Receptors Impaired in Fibromyalgia Patients

Chronic idiopathic pain associated with fibromyalgia is complex to manage and is often associated with other co-morbidities such as depression. A recently published University of Michigan study looked closely at µ-opioid receptor availability in fibromyalgia patients, providing sound physiologic data confirming the widespread consensus that the inability of these patients to process pain signals effectively is largely due to the inability of receptors in key areas of the central nervous system to bind to analgesic opioids.

The clinical management of fibromyalgia is very complex and requires a multi-modal approach to pain management that is specific to the individual patient.  Narcotic pain medications are largely ineffective at mitigating idiopathic pain in fibromyalgia patients and often lead to many more serious side-effects that can exacerbate and prolong the condition. The widespread use of narcotics to manage non-malignant chronic pain is a serious problem in the United States and there is no medical evidence showing that these drugs actually work to treat the chronic pain of fibromyalgia. The study’s results are further evidence for clinicians that the use of non-narcotic interventions for pain management of fibromyalgia are more effective treatment options.

Medical foods are a good example of a therapeutic alternative for the treatment of fibromyalgia.  These prescription-only medications treat the nutritional deficiencies in chronic disease and not just the symptoms.  Patients diagnosed with fibromyalgia, for example, may have an increased need for precursors of the neurotransmitters nitric oxide, GABA (gamma-amino butyric acid), serotonin, and acetylcholine.  These include amino acids and nutrients such as arginine, glutamate, tryptophan, acetyl-L-carnitine, and choline. The clinical dietary management of fibromyalgia contains the specific elements the body requires to stimulate production of the neurotransmitters required to support effective pain control.

As a practicing board-certified rheumatologist and internist, I have prescribed medical foods to patients for the treatment of fibromyalgia for a number of years.  Healthcare providers and patients interested in a more efficacious treatment for fibromyalgia with little or no side effects should familiarize themselves with the class of medications regulated by the FDA as medical foods.

The Nutritional Management of Disease

The connections among nutrition, disease prevention, and health maintenance are established and well accepted.  However, the nutritional aspects of certain disease states are less well understood. Patients suffering from PTSD, depression, Fibromyalgia, peripheral neuropathy, obesity, hypertension, pain syndromes, and even cognitive impairment often have metabolic abnormalities that affect how nutrients and amino acids are metabolized. Disease, exposure to certain toxic chemicals, stress, and even some pharmaceuticals can alter the nutritional requirements of an individual and exacerbate or prolong their condition (1) (2) (3). For patients suffering from disordered metabolic processes associated with a disease or toxic exposure, the modification of dietary intake is insufficent to meet the body’s increased demand for certain nutritional components.  Recognizing and correcting these deficits with specific formulations is an integral part of the medical management of certain disease states and potentially the most important component of clinical care.

The distinctive nutritional needs associated with a disease reflect the total amount needed by a healthy person to support life or maintain homeostasis, adjusted for the distinctive changes in the nutritional needs of the patient as a result of the effects of the disease process on absorption, metabolism and excretion. Medical foods such as Theramine® which is specifically formulated to address the altered metabolic processes associated with pain and inflammation, go beyond simple dietary interventions, and are specifically formulated to meet the distinctive nutritional requirements of a specific disease that cannot be met with a simple dietary shift. The increased nutritional requirements of a disease can be the result of inadequate ingestion of nutrients, malabsorption, impaired metabolism, loss of nutrients due to diarrhea, increased nutritional turnover rates inherent in certain disease states, or the impact of drug therapies. The nutritional requirements of an individual suffering from a disease can be considerably different from those of a healthy individual. Recognizing and managing these increased nutritional requirements is an integral part of the medical management of complex clinical conditions.

 

1. Blunted Circadian Variation in Autonomic Regulation of Sinus Node Function of Veterans with Gulf War Syndrome. Haley, RW et al. 2004, The American Journal of Medicine, pp. 469-478.
2. Perfusion deficit to cholinergic challenge in veterans with Gulf War Illness. Liu, P et al. 2011, NeuroToxicology, pp. 242-246.
3. Gulf War illness: Effects of repeated stress and pyridostigmine treatment on blood-brain barrier permeability and cholinesterase activity in rat brain. Amourette, C et al. 207-214, 2009, Vol. 203.