Lipid profile in patients with fibromyalgia and myofascial pain syndromes

Can the monocyte-to-HDL ratio be used as an inflammation marker in patients with fibromyalgia syndrome?

Background and Aim

The monocyte-to-high-density lipoprotein (HDL) ratio (MHR) may be used as a marker of inflammation and oxidative stress. This study aimed to evaluate the use of MHR and platelet markers in patients with fibromyalgia syndrome (FMS) and demonstrate MHR's relationship with inflammation, the Fibromyalgia Impact Questionnaire (FIQ), and quality of life.

Materials and Methods

Ninety FMS patients and 90 healthy controls, whose clinical and laboratory evaluations were performed simultaneously, were included in the study. The monocyte, platelet, HDL, MHR, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), mean platelet volume (MPV), and platelet distribution width (PDW) values of all patients were evaluated. The quality of life of the participants was assessed using the FIQ and their general health using the health assessment questionnaire (HAQ).

Results

Age, body mass index (BMI), and marital status distribution were similar in both groups. The FMS patients had a mean disease duration of 11.29 ± 2.62 months. The median monocyte, platelet, MPV, visual analog scale (VAS), FIQ, and HAQ values and the mean MHR of the FMS patients were significantly higher than the control group, while the mean HDL level was significantly lower (P < 0.05). There was a weak negative correlation between the MPV and HAQ score and the PDW and HAQ score (rs = -0.225, P = 0.042 and rs = -0.249, P = 0.024, respectively), whereas no correlation was detected between the MHR and the FIQ and HAQ scores in FMS patients. According to the receiver operating characteristic curve analysis, MHR had prediction of FMS (P = 0.002; sensitivity = 0.63, specificity = 0.50, cut-off point ≥8.4).

Conclusions

Our results suggest that the monocyte, platelet, HDL, MHR, and MPV parameters can be used in the evaluation of inflammation in FMS patients.

Objective Evaluation of Chronic Low-Back Pain Using Serum Lipids: The Role of the Doctor-Patient Relationship

Statistical data show that pain intensity in patients with low back pain is associated with a higher BMI, total serum cholesterol, and triacylglycerol levels. The objective of our study was to evaluate how these associations are dependent on the nature of the patient-doctor relationship. Eighty-nine patients hospitalized with chronic low-back pain (50 women, 39 men; average age: 64.5 ± 12.7 years) were assessed over a 3-year period. A serum lipid analysis was conducted (LDL-C, HDL-C, and total cholesterols) at admission in parallel with a subjective evaluation of pain intensity, which was assessed using a numeric rating scale. The participating physician assigned, based on their personal interaction with the patient, an attribute of affinity (positive, neutral, and negative) towards them. Current serum lipid levels and pain intensity were correlated relative to these attributes. Pain intensity did not differ between the groups assigned positive or negative attributes of affinity. In patients belonging to the “positive” group, pain intensity correlated positively with total cholesterol ( $p=0.01$ ) and LDL cholesterol ( $p=0.007$ ). No correlations were found in the “negative” group or when the patient-doctor relationship was ignored. We found a significant association between subjectively assessed low back pain intensity and serum levels of total and LDL cholesterol in patients with whom the physician had a positive affinity. A positive affinity with the patients having chronic pain and the patient’s trust in their physicians may ultimately mean that the patient’s statement about pain is more credible, which may retroactively affect the outcome of therapy.

Hemorheological parameters in patients with fibromyalgia syndrome

AIM

To evaluate hemorheological parameters in patients with fibromyalgia syndrome (FMS) in order to elucidate the etiology of the disease.

METHODS

Twenty-three adult FMS patients and 20 healthy controls were enrolled in the study. Diabetics, hypertensives and those with any rheumatological disorder or use drugs or smoking cigarette were excluded from the study. Following parameters were analyzed in each subject; erythrocyte deformability, erythrocyte aggregation, plasma viscosity, complete blood count, fasting blood glucose, fibrinogen, albumin, globulin and lipid profile.

RESULTS

Erythrocyte elongation indices indicating deformability of erythrocytes were higher in FMS patients (0.564±0.002 at 16.87 mPa and 0.605±0.002 at 30 mPa shear rate) than controls (0.558±0.001 at 16.87 mPa and 0.600±0.003 at 30 mPa shear rate). Erythrocyte aggregation speed was higher in FMS patients (2.1±0.1 s) than controls (2.3±0.2 s). Erythrocyte aggregation index was also higher in FMS patients (65.5±1.3) than controls (62.9±1.5). Erythrocyte aggregation amplitude and plasma viscosity values were similar in both groups (both p > 0.05). Among the complete blood count and biochemical parameters, only albumin levels were lower in the FM patients than controls (p < 0.05).

CONCLUSION

Our results indicate higher erythrocyte deformability and quicker erythrocyte aggregation in FM patients.

Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls

Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.

Nitric Oxide, Inflammation, Lipid Profile, and Cortisol in Normal- and Overweight Women With Fibromyalgia

Objectives:

Research has identified many factors associated with fibromyalgia (FM), but findings have been inconsistent. This study aimed to investigate changes in levels of nitric oxide (NO), inflammatory markers, lipid profile, and cortisol in normal- and overweight patients with FM and controls. Since most patients with FM are overweight, we explored possible changes in these markers according to body mass index (BMI).

Methods:

This preliminary study was performed on serum samples of women with FM and age-matched controls, grouped according to their BMI: 12 normal-weight patients and 12 controls and 13 overweight patients and 8 controls. Ozone-based chemiluminescence assay was used to measure NO. Inflammatory mediators and cortisol were determined by immunoassay. Lipid profile was measured by a spectrophotometric procedure. Functional capacity was assessed by the fibromyalgia impact questionnaire (FIQ).

Results:

Normal-weight patients showed higher levels of C-reactive protein (CRP) and apolipoprotein B compared to controls (both p < .05). CRP, apolipoprotein B, and triglycerides were higher in overweight patients versus overweight controls (all p < .05) and in overweight versus normal-weight patients (CRP p < .01; apolipoprotein B, triglycerides p < .05). The other markers were unaffected. Apolipoprotein B ( r = .762; p < .05) and NO ( r = −.921; p < .05) levels correlated with FIQ score in normal-weight patients. CRP level correlated with FIQ ( r = .912; p < .05) in overweight patients.

Conclusions:

CRP and apolipoprotein B, biomarkers linked to cardiovascular events, may be associated with FM-related dysfunction in normal- and overweight women with FM. Their increased levels in these patients may indicate an increased risk of cardiovascular disease.

Increased oxidative stress and coenzyme Q10 deficiency in juvenile fibromyalgia: amelioration of hypercholesterolemia and fatigue by ubiquinol-10 supplementation

Fibromyalgia (FM) is characterized by generalized pain and chronic fatigue of unknown etiology. To evaluate the role of oxidative stress in this disorder, we measured plasma levels of ubiquinone-10, ubiquinol-10, free cholesterol (FC), cholesterol esters (CE), and free fatty acids (FFA) in patients with juvenile FM (n=10) and in healthy control subjects (n=67). Levels of FC and CE were significantly increased in juvenile FM as compared with controls, suggesting the presence of hypercholesterolemia in this disease. However, plasma level of ubiquinol-10 was significantly decreased and the ratio of ubiquinone-10 to total coenzyme Q10 (%CoQ10) was significantly increased in juvenile FM relative to healthy controls, suggesting that FM is associated with coenzyme Q10 deficiency and increased oxidative stress. Moreover, plasma level of FFA was significantly higher and the content of polyunsaturated fatty acids (PUFA) in total FFA was significantly lower in FM than in controls, suggesting increased tissue oxidative damage in juvenile FM. Interestingly, the content of monoenoic acids, such as oleic and palmitoleic acids, was significantly increased in FM relative to controls, probably to compensate for the loss of PUFA. Next, we examined the effect of ubiquinol-10 supplementation (100 mg/day for 12 weeks) in FM patients. This resulted in an increase in coenzyme Q10 levels and a decrease in %CoQ10. No changes were observed in FFA levels or their composition. However, plasma levels of FC and CE significantly decreased and the ratio of FC to CE also significantly decreased, suggesting that ubiquinol-10 supplementation improved cholesterol metabolism. Ubiquinol-10 supplementation also improved chronic fatigue scores as measured by the Chalder Fatigue Scale.

Clinical symptoms in fibromyalgia are associated to overweight and lipid profile

In order to analyze the association between body mass index (BMI), lipid profile and clinical symptoms in patients with fibromyalgia, we assessed BMI levels, lipid profile and its association with clinical symptoms in 183 patients with fibromyalgia. The patients were evaluated using tender points, FIQ and Visual Analogue Scales of pain (VAS). Serum lipid profile analysis (total cholesterol, triglyceride, HDL, LDL and VLDL), and biochemical parameters were measured in the biochemistry laboratory. The BMI distribution of the nonobese, overweight and obese patients' groups were relatively even with 37.7, 35.5 and 26.8%, respectively, with a mean BMI of 27.3 ± 4.9. The number of tender points showed significantly positive correlation with higher BMI (P < 0.05). A total of 57.9% of patients showed increased levels of total cholesterol, 63.4 % increased levels of LDL cholesterol and 19.9% high levels of triglycerides. BMI, total cholesterol and triglycerides showed high association with some clinical parameters. Overweight and lipid profile could be associated with fibromyalgia symptoms. A treatment program with weight loss strategies, and control in diet and increased physical activity is advised to patients.

Serum lipid profile in fibromyalgia women

The etiology and pathogenic mechanisms of fibromyalgia (FM) syndrome are unknown. A number of studies have shown that there is an association between some of the musculoskeletal system diseases and hyperlipidemia. The aims of this study were (1) to compare the serum lipid profile among FM and healthy women and (2) to investigate the relationship between serum lipid levels and FM findings. One hundred sixty-four women (82 women with FM as study group and 82 healthy women as control group) were enrolled in the study. The mean serum total cholesterol and low-density lipoprotein cholesterol (LDL-c) were found significantly higher in the FM group than that in the control group (p<0.05). However, There was no statistically significant difference in the mean serum triglyceride, high-density lipoprotein cholesterol (HDL-c), and very low-density lipoprotein cholesterol (VLDL-c) values between the two groups (p>0.05). In the FM group, we could not find a significant correlation between the serum lipid profile values and the FM parameters (p>0.05).

Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome

BACKGROUND

Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrP).

OBJECTIVES

This prospective, single-blind study was proposed to compare TrP injection with botulinum toxin type A (BTX-A) to dry needling and lidocaine injection in MPS.

METHODS

Eighty-seven trigger points (cervical and/or periscapular regions) in 23 female and six male patients with MPS were treated and randomly assigned to three groups: lidocaine injection (n=10, 32 TrP), dry needling (n=10, 33 TrP), and BTX-A injection (n=9, 22 TrP).

OUTCOME MEASURES

Clinical assessment including cervical range of motion, TrP pain pressure threshold (PPT), pain scores (PS), and visual analog scales for pain, fatigue, and work disability were evaluated at entry and the end of the 4th week. Additionally, depression and anxiety were evaluated with the Hamilton depression and anxiety rating scales, and quality of life was assessed using the Nottingham health profile (NHP). The subjects were also asked to describe side effects. INJECTION PROCEDURE: One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10-20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. The patients were instructed to continue their home exercise programs.

RESULTS

Pain pressure thresholds and PS significantly improved in all three groups. In the lidocaine group, PPT values were significantly higher than in the dry needle group, and PS were significantly lower than in both the BTX-A and dry needle groups. In all, visual analog scores significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Disturbance during the injection procedure was lowest in the lidocaine injection group. Quality of life scores assessed by NHP significantly improved in the lidocaine and BTX-A groups but not in the dry needle group. Depression and anxiety scores significantly improved only in the BTX-A-injected group.

CONCLUSIONS

Injection is more practical and rapid, since it causes less disturbance than dry needling and is more cost effective than BTX-A injection, and seems the treatment of choice in MPS. On the other hand, BTX-A could be selectively used in MPS patients resistant to conventional treatments.