The researchers said that compared with placebo, low-dose opioid receptor antagonist naltrexone (ReVia) can alleviate fibromyalgia-associated pain by targeting the immune pathway of pain.
In a small randomized crossover trial, patients with fibromyalgia who received naltrexone reported significantly less pain relief than placebo, and Dr. Jarred Younger of Stanford University School of Medicine and colleagues reported at the American College of Pain Medicine Academy meeting. .
Younger said in an oral report: "The key is not its role in antagonizing opioids, but a separate effect on microglia."
There is growing interest in pain-related immune pathways. The core of the study is that human glial cells, including microglia and astrocytes, can be disseminated when activated by certain biological triggers (such as opioids). Inflammatory cytokines.
Dr. Linda Watkins of the University of Colorado, Denver, delivered a keynote speech at the conference unrelated to Younger's report. She explained that these cytokines can send information to pain neurons.
To stop the inflammatory response, researchers have targeted the glial cells to Toll-like receptor 4 (TLR-4).
Younger said that, in fact, naltrexone can block the immune response and eventually alleviate the symptoms of fibromyalgia by blocking microglia TLR-4.
In an early pilot study, he and his colleagues demonstrated that low-dose naltrexone (4.5 mg/day) reduced pain and fatigue in 10 women with fibromyalgia (Pain Med 2009; 10:663-672). .
They expanded their early studies and conducted a placebo-controlled, double-blind, crossover trial involving 30 women; they took 2 weeks at baseline, followed by 12 weeks of low-dose naltrexone and 4-week placebo. Combined with 4 weeks of follow-up. These women complete symptom reports daily, the main result being daily pain.
Younger and colleagues found that patients who received low-dose naltrexone reported a greater reduction in pain than those who received placebo (48.5% vs 27.4%, P=0.006).
Of the patients receiving low-dose naltrexone, only one-half had a slight improvement, except for half who reported a feeling of greatness or improvement, Younger said.
He added that naltrexone had no effect on fatigue or quality of sleep, and patients reported that low-dose naltrexone was as well tolerated as placebo (89.2% Vs 89.4%, rated 100 points).
In the report, the more common side effects of low-dose naltrexone were realistic dreams [37% (naltrexone) Vs 13% (placebo)] and headache (16% Vs 3%).
Younger said that other drugs may also improve pain through the immune route, including naloxone, fluorocitrate, minocycline and dextromethorphan. He added that some generic drugs for these drugs are available for purchase, which will make them significantly cheaper.
But Watkins said that several companies have been seeking to develop new compounds for glial cells to treat chronic pain. The main area of ​​research is the inhibition of TLR-4 by naloxone, which reduces pain—though the drug has so far only been studied in animal models.
"Immunologists ignore pain, and pain patients ignore immunology," Watkins said. "This is the result. They are intertwined."
Younger said that while low-dose naltrexone appears to be effective in treating fibromyalgia and is well tolerated and inexpensive, further randomized controlled trials are needed.
In a small randomized crossover trial, patients with fibromyalgia who received naltrexone reported significantly less pain relief than placebo, and Dr. Jarred Younger of Stanford University School of Medicine and colleagues reported at the American College of Pain Medicine Academy meeting. .
Younger said in an oral report: "The key is not its role in antagonizing opioids, but a separate effect on microglia."
There is growing interest in pain-related immune pathways. The core of the study is that human glial cells, including microglia and astrocytes, can be disseminated when activated by certain biological triggers (such as opioids). Inflammatory cytokines.
Dr. Linda Watkins of the University of Colorado, Denver, delivered a keynote speech at the conference unrelated to Younger's report. She explained that these cytokines can send information to pain neurons.
To stop the inflammatory response, researchers have targeted the glial cells to Toll-like receptor 4 (TLR-4).
Younger said that, in fact, naltrexone can block the immune response and eventually alleviate the symptoms of fibromyalgia by blocking microglia TLR-4.
In an early pilot study, he and his colleagues demonstrated that low-dose naltrexone (4.5 mg/day) reduced pain and fatigue in 10 women with fibromyalgia (Pain Med 2009; 10:663-672). .
They expanded their early studies and conducted a placebo-controlled, double-blind, crossover trial involving 30 women; they took 2 weeks at baseline, followed by 12 weeks of low-dose naltrexone and 4-week placebo. Combined with 4 weeks of follow-up. These women complete symptom reports daily, the main result being daily pain.
Younger and colleagues found that patients who received low-dose naltrexone reported a greater reduction in pain than those who received placebo (48.5% vs 27.4%, P=0.006).
Of the patients receiving low-dose naltrexone, only one-half had a slight improvement, except for half who reported a feeling of greatness or improvement, Younger said.
He added that naltrexone had no effect on fatigue or quality of sleep, and patients reported that low-dose naltrexone was as well tolerated as placebo (89.2% Vs 89.4%, rated 100 points).
In the report, the more common side effects of low-dose naltrexone were realistic dreams [37% (naltrexone) Vs 13% (placebo)] and headache (16% Vs 3%).
Younger said that other drugs may also improve pain through the immune route, including naloxone, fluorocitrate, minocycline and dextromethorphan. He added that some generic drugs for these drugs are available for purchase, which will make them significantly cheaper.
But Watkins said that several companies have been seeking to develop new compounds for glial cells to treat chronic pain. The main area of ​​research is the inhibition of TLR-4 by naloxone, which reduces pain—though the drug has so far only been studied in animal models.
"Immunologists ignore pain, and pain patients ignore immunology," Watkins said. "This is the result. They are intertwined."
Younger said that while low-dose naltrexone appears to be effective in treating fibromyalgia and is well tolerated and inexpensive, further randomized controlled trials are needed.
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