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Saturday 18 March 2006

Special Clinic for FMS and CFS, Trier, Germany

By: Lucas HJ, Brauch CM, Settas L, Theoharides TC

Fibromyalgia (FMS) is a debilitating disorder characterized by chronic

diffuse muscle pain, fatigue, sleep disturbance, depression and skin


There are no genetic or biochemical markers and patients often present with other comorbid diseases, such as migraines, interstitial cystitis and irritable bowel syndrome.

Diagnosis includes the presence of 11/18 trigger points, but many patients with early symptoms might not fit this definition.

Pathogenesis is still unknown, but there has been evidence of increased corticotropin-releasing hormone (CRH) and substance P (SP) in the CSF of FMS patients, as well as increased SP, IL-6 and IL-8 in their serum. Increased numbers of activated mast cells were also noted in skin biopsies.

The hypothesis is put forward that FMS is a neuro-immunoendocrine disorder where increased release of CRH and SP from neurons in specific muscle sites triggers local mast cells to release proinflammatory and neurosensitizing molecules. There is no curative treatment although low doses of tricyclic
antidepressants and the serotonin-3 receptor antagonist tropisetron, are helpful.

Recent nutraceutical formulations containing the natural anti-inflammatory and mast cell inhibitory flavonoid quercetin hold promise since they can be used together with other treatment modalities.

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