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Fibromyalgia, chronic fatigue and generalized muscle pain

Fibromyalgia, chronic fatigue and generalized muscle pain

Fibromyalgia (FM) (etymologically the term comes from Latin and Greek: muscle pain in the connective tissue) is a group of symptoms and musculoskeletal disorders, which is characterized by extreme fatigue, constant pain, stiffness of varying intensity of the surrounding muscles, tendons and soft tissues, as well as a wide range of other psychological symptoms, such as difficulty falling asleep, morning stiffness, headaches and memory problems (the so-called “mental” gaps – which often interfere with the patient’s routine functioning).

Diagnosis is a controversial process due to the lack of abnormalities when physically examining and conducting laboratory tests. The results of specialized medical tests to confirm the diagnosis are also contradictory. Today, there are new biomarkers, such as the activity of the enzyme diaminoxidase (DAO), for which methods of diagnosis and concomitant treatment have been developed.

Symptoms of fibromyalgia, chronic fatigue and ge muscle pain

The main characteristic element of fibromyalgia is diffuse and widespread musculoskeletal pain or stiffness, affecting at least 3 anatomical localizations, more than 3 months, without which the diagnosis of the disorder can not be made. The pain is usually severe and in many cases difficult to describe. In general, it gets worse with intense physical exertion, cold and emotional stress.

Common areas where symptoms of fibromyalgia occur include the lumbar region, neck, area of the trapezius muscle, chest and thighs. In some cases, muscle spasms and / or contraction occur.

Additional symptoms may include headaches, migraine, restless leg syndrome, difficulty concentrating and difficulty remembering, tinnitus and some neurological symptoms of motor coordination.

Between 70 and 90% of fibromyalgia patients also suffer from sleep disorders, expressed as restless, shallow and unstable sleep. Other symptoms include weight loss asthenia, changes in the urinary system, stiffness in the upper or lower limbs and very often major depressive episodes accompanied by a crisis of anxiety.

Fatigue is present in all activities carried out by people with fibromyalgia, so daily tasks become inevitable, difficult. Depending on the severity, this fatigue can vary from a tolerable state to an almost permanent one, which limits activities both at home and professionally.

Poor sleep quality is another symptom that is directly related to fatigue. In combination, these two problems create a vicious circle in which the patient is constantly tired, but can not get enough sleep and all daily activities are affected.

The role of histamine in the etiology of fibromyalgia, chronic fatigue and pain

As for the treatment, it is considered that at the moment there is no cure for fibromyalgia. The therapy is aimed at relieving the symptoms, requiring the intervention of a multidisciplinary team.

Before establishing the link between DAO and fibromyalgia, the most used treatment methods were antidepressants, muscle relaxants, serotonin reuptake inhibitors, NSAIDs. In addition, the following therapies are considered appropriate – rehabilitation, myofascial cranial sacral therapy, massage, chiropractic, osteopathy, stretching and aerobic exercises, improving posture, relaxation and acupuncture.

Musculoskeletal pain common to all people suffering from fibromyalgia and chronic fatigue syndrome, as well as other additional symptoms of both diseases are the result of dilation of blood vessels. This effect is due to vasodilators, mainly histamine in the body. As it accumulates, it begins to be deposited in muscle tissue. Thus, histamine has a direct effect on various manifestations of pain characteristic of people suffering from fibromyalgia and chronic fatigue.

Histamine [2- (4-imidazolil) -ethylamine] is an important mediator of many biological processes, including inflammation, gastric acid secretion, neuromodulation and regulation of immune function. Histamine is produced by the body and kept in inactive form in the metachromatic granules of basophilic mast cells and leukocytes, where it is available for immediate release. After release, histamine is an extremely powerful mediator of many physiological and pathophysiological processes, often through interaction with cytokines.

Histamine can also enter the human body from the outside, since it is generated by microbial action during the processing of food, and therefore is present in significant quantities in many fermented foods and beverages.

Therefore, after taking certain foods, a significant increase in histamine in the bloodstream is observed.

Enzyme diaminoxidase (DAO): a new biomarker for fibromyalgia, chronic fatigue and generalized muscle pain

The main inactivation route of absorbed histamine is the oxidative desamination of the primary amino group catalyzed by the enzyme diaminoxidase (DAO) to result in imidazole acetaldehyde.

The main function of DAO is to prevent the histamine ingested from food from reaching the bloodstream. In addition to histamine, DAO can degrade other biogenic amines such as putrescin, spermidine and cadaverine. It has a molecular weight of about 182 kDa and a percentage of carbohydrates of 11%. It belongs to the class of copper-containing amino acids that catalyze the oxidative deamination of primary amines to produce aldehydes, ammonia and hydrogen peroxide. DAO uses molecular oxygen to deaminate histamine to imidazole acetaldehyde via oxidation, ammonia and hydrogen peroxide.

DAO is found mainly in the small intestine, liver, kidneys and leukocytes. Blood DAO levels in pregnant women are about 500 to 1000 times higher, as they produce additional DAO in the placenta to protect the fetus during its development (therefore, fibromyalgia symptoms may disappear during pregnancy). Histamine is continuously produced in the body and is excreted from the intestinal tract, being decomposed passing through the intestinal mucosa by dao, which is there.

DAO is a sensitive enzyme that can be inhibited by various substances, such as other biogenic amines, alcohol and acetaldehyde, as well as various drugs, paradoxically prescribed for the palliative treatment of muscle pain and fibromyalgia.

In addition to inhibition of DAO by certain types of substances, there is a significant percentage of the population whose DAO values in the blood are abnormally low, which means that the level of histamine in the blood is higher than the values considered normal (2-20 micrograms / 0.1 l). This type of person suffers from a number of pathologies caused by these high levels of histamine in the blood, including fibromyalgia and / or muscle pain.

Diagnosis and treatment of fibromyalgia, chronic fatigue and generalized muscle pain caused by DAO deficiency: DAO treatment and DAO activity

The determination of DAO- levels is a new and important biomarker for the objective diagnosis of fibromyalgia and chronic fatigue, both through genetic testing of implicit genotypes and a plasma measurement of its activity, or a combination of both.

After a diagnosis of fibromyalgia, chronic fatigue syndrome or generalized muscle pain and DAO deficiency, proactive treatment with DAO supplements helps break down excess histamine, thereby preventing the development of symptoms.

The treatment consists of supplementing the diet with exogenously obtained DAO, along with the elimination of foods with a high content of histamine. When prescribing DAO, treatment should also take into account the elimination of drugs identified as histamine activators and / or DAO inhibitors.

Thus, DAO (nutraceutical) treatment represents a new approach in preventive therapy for fibromyalgia, chronic fatigue and generalized muscle pain, with minimal risk of adverse effects


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