Is insulin resistance the cause of fibromyalgia? A preliminary report

Fibromyalgia (FM) is one of the most frequent generalized pain disorders with poorly understood neurobiological mechanisms. This condition accounts for an enormous proportion of healthcare costs. Despite extensive research, the etiology of FM is unknown and thus, there is no disease modifying therap...

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Bibliographic Details
Published in:PloS one 2019-05, Vol.14 (5), p.e0216079-e0216079
Main Authors: Pappolla, Miguel A, Manchikanti, Laxmaiah, Andersen, Clark R, Greig, Nigel H, Ahmed, Fawad, Fang, Xiang, Seffinger, Michael A, Trescot, Andrea M
Format: Article
Language:English
Subjects:
Analysis
Biology and life sciences
Cardiovascular disease
Care and treatment
Complications and side effects
Diabetes
Diabetes mellitus
Duloxetine
Economic aspects
Etiology
Etiology (Medicine)
Fibromyalgia
Glucose
Glycosylated hemoglobin
Health care
Health care costs
Hemoglobin
Hemoglobins
Hypoglycemic agents
Insulin
Insulin resistance
Kinases
Laboratories
Medical economics
Medicine
Medicine and Health Sciences
Metformin
Milnacipran
Neuromuscular diseases
Pain
Pain management
Population
Prediabetic state
Regression analysis
Regression models
Risk factors
Subgroups
Treatment outcome
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Summary:Fibromyalgia (FM) is one of the most frequent generalized pain disorders with poorly understood neurobiological mechanisms. This condition accounts for an enormous proportion of healthcare costs. Despite extensive research, the etiology of FM is unknown and thus, there is no disease modifying therapy available for this condition. We show that most (if not all) patients with FM belong to a distinct population that can be segregated from a control group by their glycated hemoglobin A1c (HbA1c) levels, a surrogate marker of insulin resistance (IR). This was demonstrated by analyzing the data after introducing an age stratification correction into a linear regression model. This strategy showed highly significant differences between FM patients and control subjects (p < 0.0001 and p = 0.0002, for two separate control populations, respectively). A subgroup of patients meeting criteria for pre-diabetes or diabetes (patients with HbA1c values of 5.7% or greater) who had undergone treatment with metformin showed dramatic improvements of their widespread myofascial pain, as shown by their scores using a pre and post-treatment numerical pain rating scale (NPRS) for evaluation. Although preliminary, these findings suggest a pathogenetic relationship between FM and IR, which may lead to a radical paradigm shift in the management of this disorder.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0216079