[Abstract Title]. - Society for Neuroscience

Poster
267. Pain: Pain Models II
Time: Sunday, November 16, 2008, 1:00 pm - 5:00 pm
Program#/Poster#: 267.19/FF25
Topic: D.08.j. Pain models
Title: Structural and functional mitochondrial pathology in fibromyalgia
Authors: *A. D. KONSTANTINIDOU 1 , I. FOUZAS 2 , D. G. TSAMIS 1 , A. N. FLARIS 3 , D. I.
DARDAVESIS 1 , M. K. N. FLARIS 1 ;
1 Pharmacol, Protypon Neuromuscular Ctr., Thessaloniki 54635, Greece; 2 Transplant Surgery,
3 Sch. of Med., Aristotelian Univ.of Thessaloniki, Thessaloniki 54635, Greece
Abstract: Fibromyalgia is a disease whose very existence is still debated and its pathology
remains elusive. A total of 39 patients (white, 5 men, aged 36-51, mean 39, and 34 women, aged
17-78, mean 49) were evaluated in our outpatient neuromuscular center, previously examined by
other physicians (including rheumatologists), with the main symptom of continuous pain of more
than 3 months with a history of widespread pain and tender points, carrying a diagnosis of
fibromyalgia. The patients had previously tried several medications including NSAIs and
antidepressants without clear help. All underwent a standard detailed neurologicalneuromuscular
examination and an extensive laboratory investigation including CBC, ESR,
ANA, CPK and lactate. They all had a modified lactate/NH3 ischemia test done (Munsat T.L.,
Neurology,1970). Resting lactate levels averaged 11.73mg/dL (nl 4.5-22mg/dL) and 15' lactate
levels averaged 17.4mg/dL. EMGs were performed and were abnormal: 31/38 with evidence of
active ongoing disease, 7/38 with chronic involvement as evidenced by polyphasic potentials.
The final test was a muscle biopsy, snap frozen in the OR. All biopsies were abnormal. Biopsies
had varying degrees of mitochondrial pathology (39/39), with Ragged Red Fibres in 28/39 and
Cytochrome Oxidase Negative Fibres in 38/39. Metabolic dysfunction was frequently noted in
35/39 biopsies, with lipid accumulation (30/39) and glycogen accumulation (25/39).
Inflammatory changes (MHC I positive in 29/39) were noted in 30/39 patients, with clear focal
inflammation in 13/39 biopsies. Following these investigations, the patients were told of the
results and placed on our standardized treatment (Q10, carnitine, B12, folic acid). When the
inflammation was severe, prednisone (2/39) or methotrexate (1/39) was added. When it was less
severe, a combination of quercetin, glucosamine and chondroitin with kernel olive oil was added
(10/39). All patients related improvement within 3 months (some as early as 1 month), although
significant improvement was seen a year later, coupled with improved scores in follow-up
dynamometry testing and reduced resting lactate levels. Follow up EMGs were done in 4 patients
and all improved with 3 out of 4 rendered inactive. It appears that fibromyalgia, at least some
forms of it, are related to mitochondrial/ metabolic /inflammatory muscle pathology and