Saturday, January 16, 2016
Fibromyalgia ... An autoimmune disease within the opioid system?
Based on our findings and fibromyalgia’s observed preponderance for women, we hypothesize that fibromyalgia is an autoimmune disease targeting the endogenous opioid system. The female:male ratio is 3:1, which is the exact ratio seen in other autoimmune diseases. Patients who are able to respond to LDN may have a low-functioning opioid system that can be stimulated by a transient blockade of the opioid receptors. This stimulation presumably causes an increase in opioid tone allowing the system to return to a level more closely resembling the range of “healthy functioning” illustrated in Figure 1. We hypothesize that non-responders have had their opioid system ravaged to such a degree that they have little left to stimulate. In our study, 4 of the 20 patients showed little change in CPT. These include 3 patients whose CPT actually worsened with LDN.
Low-dose naltrexone would be an ameliorative agent for fibromyalgia if sufficient opioid function remained after an autoimmune attack on the system. Stimulating the remaining opioidergic cells or receptor systems might return opioid tone towards the normal range. This concept could be tested using a double blind randomized study. Beta-endorphin levels might be followed to see if they increased, and if the increase was correlated with remission of fibromyalgia symptoms.