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Fibromyalgia

Fibromyalgia
Is a frequent disease that is characterized by the existence of many symptoms together at the same time. The main symptom is the generalized pain of the musculoskeletal system, i.e. muscles, ligaments and joints, but it is accompanied by significant fatigue, sleep disturbances, loss of concentration and memory, anxiety and sadness. The most recent research has found that in fibromyalgia there is an alteration in the neurotransmitters, that is, the substances that allow the communication between the neurotransmitters and the nerve cells.

Also recent studies determine that oxidative stress, inflammation and mitochondrial dysfunction together with deficiencies of CoQ10 demonstrate an important role in the origin of fibromyalgia. These studies provide new insights into FM and suggest new therapeutic interventions for disease.

Neurotransmitters such as Serotonin, Noradrenaline, Adrenaline, Dopamine and many others, when they are produced in adequate amounts and at the precise times, achieve a correct functioning of all the circuits of the nervous system. When there is an alteration in their production, the circuits that depend on them are functioning badly, causing the symptoms of the disease. This is precisely what happens to the pathways of pain, where a malfunction of the responsible neurotransmitters leads to a situation in which the perception of some stimulus is greater than usual, and produces the generalized pain so characteristic of fibromyalgia. The specific causes that produce fibromyalgia are not known. Many possible causes have been studied such as viral infections, hormonal diseases, muscular or toxic environmental diseases, among others, but at the present time we still do not know them.

Energy and Metabolism

Our body needs energy to maintain our vital functions, the cells of our tissues produce that energy through Cellular Metabolism. Mitochondria are the cellular organelles responsible for supplying energy to cells (ATP) for proper cellular function. Metabolism requires hundreds of chemical reactions. When one of the intermediaries in such reactions does not work, an energy crisis occurs. Incomplete metabolism products can accumulate in the body in the form of Free Radicals and other compounds. Such products may interrupt other major chemical reactions, worsening the crisis. In addition, the same products can act as free radicals, causing damage to mitochondria over time. Producing Mitochondrial Diseases.

Mitochondrial Diseases

Are the result of failure in the functioning of the mitochondria, in turn, constituent parts of the organism cells whose function is to generate the necessary energy to maintain life, development and correct organs and systems functioning.

Fibromyalgia is associated with mitochondrial dysfunction and oxidative stress. Recent studies have shown that oxidative stress may play a role in fibromyalgia physiology, and that coenzyme Q10 deficiency, demonstrated in mononuclear blood cells of patients with Fibromyalgia alters the function of the mitochondria. (Cordero 2011,Cordero 2010).

Mitochondria

Mitochondria are cellular organelles responsible for supplying most of the energy required for cellular activity (cellular respiration). They act, therefore like energy centers of the cell and synthesize ATP to Muscles Skeletal expenses of the metabolic fuels ( glucose acids Fatty ).

Organs with greater Mitochondrial metabolism dependence

  • Brain, heart, liver
  • Skeletal muscles
  • Nervous system
  • Kidney, eyes, ear

These organs require more energy supply and in turn are the most sensitive in processes in the mitochondrial dysfunction.

Mitochondria is the main producer of free radicals of the cell

In states of mitochondrial disease or mitochondrial dysfunction, free radicals generated by mitochondria are very reactive in their formation due to their altered Number of valence electrons This situation produces an increase of Oxidative Stress.

Oxidative Stress

Oxidative Stress is defined as the imbalance between the production of Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) and the antioxidant defense mechanisms We have basal levels of oxidative stress, mechanisms such as the bacterial activity of phagocytes or in signal transduction or the redox state of cells are necessary for life. The problem arises in the continuous imbalance causing the origin of degenerative diseases and muscular damage.

Mitochondrial Diseases Symptoms

Motor control loss, Muscle weakness and pain, Gastrointestinal disorders. Difficulties Heart disease, Depression, Diabetes Swallowing problems, visual, cognitive, auditory.

In patients with chronic musculoskeletal pain, chronic fatigue and / or fatigue, Q10coenzyme deficiency is common. In combination with the basic nutrients, they may improve symptomatology.

Fibromyalgia and Chronic Fatigue there is evidence to administer Q10 NADH as an adjunct to conventional medical treatment.
Has recently published a macro survey conducted in France, in order to know the quality of life of people affected by this pathology, involved more than 2,100 Patients at the question:

Do you usually suffer one of these symptoms?

The result is very significant, most respondents frequently had all the symptoms described. Concentrating painful points on muscles, tendons and bones.

Frequent painful spots in Fibromyalgia.

Fibromyalgia (FM) is a chronic pain syndrome of unknown etiology and a broad spectrum of symptoms such as allodynia, debilitating fatigue, joint stiffness, and migraine. Recent studies have shown some evidence that oxidative stress is associated with clinical symptoms in FM. Recent results from our group have shown reduced levels of CoQ10, reduced mitochondrial membrane potential, increased mitochondrial superoxide levels, and increased levels of lipid peroxidation in Mononuclear blood cells of patients with FM, mitochondrial dysfunction was also associated with increased expression of autophagic genes and the elimination of dysfunctional mitochondria by mitofagia [Cordero et al., 2010]. In another study, patients with FM were clinically assessed using the Visual Analogue Pain Scale (EVA), and the Fibromyalgia Impact Questionnaire (FIQ). Patients with FM with CoQ10 deficiency showed a significant reduction in symptoms after the CoQ10 treatment [Cordero et al., 2011, 2012. Determination of CoQ10 deficiency and subsequent FM supplementation may lead to significant clinical improvement.

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a medical condition characterized by persistent and intense physical and mental fatigue for more than 6 months that is not relieved by rest. It is accompanied by severe exercise intolerance, non-restorative sleep, and concentration and memory impairment. 

 It is a ‘complex’ medical condition, more common in women, genetically related to different triggering factors, such as infectious agents, injuries, the postpartum period, chemical agents, and physical or psychological stress, which cause alterations in intracellular proteins and higher immunological activity.

 It is diagnosed using the Fukuda Criteria. According to these criteria, CFS diagnosis is based on the occurrence of 2 major criteria and the coexistence of at least 4 associated criteria, mainly related to muscular and neuropsychological symptoms.  

 According to several scientific studies, it is estimated that between 0.2 % and 6.41 % of the world population are affected by CFS (4), which results in more than 1,500,000 people only in Europe (5).

Fukuda Diagnostic Criteria 

Major Criteria (both must be present)

  1. Persistent or recurrent chronic fatigue during 6 months, which is of new or definite onset, not the result of ongoing exertion, not substantially alleviated by rest, and results in substantial reduction in previous levels of the patient’s daily activities.
  2. The exclusion of any potential medical condition that may explain the presence of chronic fatigue.


Minor criteria: 
There must be a concurrent occurrence of four or more of the following signs and symptoms, all of which must have persisted during six or more consecutive months and must not have predated the fatigue:

  1. Substantial impairment in short-term memory or concentration
  2. Oesophagodynia or sore throat
  3. Painful cervical or axillary adenopathy
  4. Myalgia
  5. Multi-joint pain without swelling
  6. Headaches of a new type or with patterns different from the usual
  7. Unrefreshing sleep

OTHER ASSOCIATED PATHOLOGIES 

 

Coexistence between CFS and other disorders aggravates prognosis, functional ability and, therefore, patient’s quality of life.  

 

There are some frequent associated pathologies, as for example: 

 

  •   Fibromyalgia
  •   Dry Eye Syndrome
  •   Myofascial Pain Syndrome
  •   Psychiatric Disorders 
  •   Sexual and Family Dysfunction 
  •   Hypersensitivities
  •   Tendinopathies 
  •   Autoimmune Diseases
  •   Vascular risk
  •   Decreases in Neurovegetative Functions

 

CFS Treatment 

 Due to the complex symptomatology of CFS and the current lack of specific pharmacological treatment, the best therapy is the one that ensures a multidisciplinary management and provides individual treatment. 

 This multidisciplinary team should be formed by specialists in internal medicine, rheumatology, primary care, clinical psychologists, psychiatrists, nursing graduates, physiotherapists, and social workers, among others. 

The multidisciplinary team’s performance will result in an improvement of the patient’s quality of life, since it will allow continuity and interaction between different education and health promotion programs. Patients with CFS will notice an improvement in their quality of life thanks to health care, socio-sanitary and social interventions.  

 Also worth mentioning are the different interconsultations and potential referrals between different clinics and units (such as those related to pain, cephalalgia, sleep, arrhythmia, and obesity or other comorbid diseases).

 Coenzyme Q10 (CoQ10) and NADP are antioxidant supplements. The benefits obtained with their administration have been thoroughly evaluated in different conditions (Braun et al. 1991, Porter et al. 1995, Malm et al. 1997, Cooke et al. 2008). Several studies have shown that there is a mitochondrial dysfunction that reduces ATP production in most CFS and/or ME patients, as a primary or secondary effect caused by symptoms of this syndrome (Twisk and Maes 2009; Booth et al. 2012; Marrero et al. 2013; Myhill et al. 2013; Castro- Marrero et al. 2016).

 Recently, the working group lead by Castro-Marrero (Castro-Marrero et al. 2017) ‘conducted a proof‐of‐concept, 8 week RCT in 80 Spanish CFS/ME patients who met the 1994 CDC/Fukuda definition and were allocated to receive CoQ10 plus NADH or matching placebo’. Their findings suggested that ‘the combination of CoQ10 plus NADH was safe and potentially effective in reducing the max HR (P = 0.022) during the exercise challenge test. There was also a trend towards a reduction in self‐reported measures of fatigue (FIS 40) in the active group compared with placebo (P = 0.030)’ (5).

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BIBLIOGRAPHY:

1,Article: Coenzyme Q10 Therapy. Juan Garrido Maraver · Mario D. Cordero · Manuel Oropesa-Ávila · Alejandro Fernández Vega · Mario de la Mata · Ana Delgado Pavón · Manuel de Miguel · Carmen Pérez Calero · Marina Villanueva Paz · David Cotán · José A. Sánchez-Alcázar. Full-text · Article · Jul 2014 · Molecular syndromology

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3,Article: Effect of coenzyme Q(10) evaluated by 1990 and 2010 ACR Diagnostic Criteria for Fibromyalgia and SCL-90-R: Four case reports and literature review- Elísabet Alcocer-Gómez · Francisco Javier Cano-García · Mario D Cordero Full-text · Article · Nov 2013 · Nutrition

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5,Article: Mutation in Cytochrome b gene of mitochondrial DNA in a family with Fibromyalgia is associated with NLRP3-Inflammasome activation. Mario D Cordero · Elísabet Alcocer-Gómez · Fabiola Marín-Aguilar · Tatyana Rybkina · David Cotán · Antonio Pérez-Pulido · José Miguel Alvarez-Suarez · Maurizio Battino · José Antonio Sánchez-Alcazar · Angel M Carrión · Ognjen Culic · José M Navarro-Pando · Pedro Bullón,Full-text · Article · Oct 2015 · Journal of Medical Genetics

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8,Article: Aging-Related Changes in Inflammatory and LKB1/AMPK Gene Expression in Fibromyalgia Patients. Elisabet Alcocer-Gómez · José Antonio Sánchez-Alcazar · Maurizio Battino · Pedro Bullón · Mario D. Cordero. Full-text · Article · Feb 2014 · CNS Neuroscience & Therapeutics

9,Article: Coenzyme Q10 Regulates Serotonin Levels and Depressive Symptoms in Fibromyalgia Patients: Results of a Small Clinical Trial.,Elísabet Alcocer-Gómez · Jose Antonio Sánchez-Alcázar · Mario D Cordero. Full-text · Article · Feb 2014 · Journal of clinical psychopharmacology

10,Article: Clinical applications of coenzyme Q10. Juan Garrido-Maraver · Mario D Cordero · Manuel Oropesa-Avila · Alejandro Fernandez Vega · Mario De La Mata · Ana Delgado Pavon · Elisabet Alcocer-Gomez · Carmen Perez Calero · Marina Villanueva Paz · Macarena Alanis · Isabel De Lavera · David Cotan · Jose A Sanchez-Alcazar. Full-text · Article · Jan 2014 · Frontiers in Bioscience

11,Article: NLRP3 Inflammasome Is Activated in Fibromyalgia: The Effect of Coenzyme Q 10,Mario D Cordero · Elisabet Alcocer-Gómez · Ognjen Culic · Angel M Carrión · Manuel de Miguel · Eduardo Díaz-Parrado · Eva M Perez-Villegas · Pedro Bullon · Maurizio Battino · José Antonio Sánchez-Alcazar,Full-text · Article · Jul 2013 · Antioxidants & Redox Signaling

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