Depending on the model of pathogenesis and treatment you use, hepatic detoxification evaluation, gastrointestinal permeability testing, digestive stool analysis, serum food allergy testing can be done.
Aberrant serotonin metabolism - reduced levels of serotonin in spinal fluid – antibodies against serotonin have been found in FMS patients.
Delta sleep interference - alpha wave intrusion leads to decrease in growth hormone, which is secreted during delta sleep - alpha EEG NREM sleep anomaly. You can induce FMS in healthy patients by depriving them of NREM sleep for three consecutive nights, unless they are highly fit and conditioned. (Moldofsky)
FM patients have a significantly lower level of tryptophane and 6 other amino acids (one study found that tryptophane supplementation had no effect on fatigue, mood or pain) - tyrosine, leucine, and isoleucine also low
Increased norepinephrine excretion, reduced levels of dopamine, norepinephrine, and serotonin in the CFS of FMS patients.
DHEA and cortisol are significantly lower in FMS patients.
Moth eaten type I muscle fibers, ragged red fibers, swollen mitochondria, atrophy of type II fibers, abnormal mitochondria, glycogen deposits in the muscle cells, mucopolysaccharide alterations. Changes are non-specific and inconsistent among patients. A network of elastic fibers not seen in healthy controls connects muscle fibers of FMS patients.
Decreased intramuscular ATP and phosphocreatinine - alteration in mitochondrial oxidative phosphorylation (Mathur &Gatter).
Compromised microcirculation - ultra sound decreases microcirculation in FMS patients, opposite the effect seen in normal patients. But, there is no difference in capillary density.
No consistent EMG changes.
Alcohol consumption increases FMS symptoms, and increases conversion of tryptophane to kynurenine.
Elevated substance P in spinal fluid - 3-6 times normal.
Auto-immune dysfunction doesn't seem to be a feature - FMS patients do not tend to get other autoimmune diseases
Fatigue, emotional distress makes it worse.
44% of men with Fibromyalgia have co-existent obstructive sleep apnea.
There is a genetic predisposition - it is runs in families, more common in relatives of patients with depression.
Patients with FMS have low somatostatin levels, low levels of GH - probably due to sleep disturbance and low serotonin levels.
There is a symptom overlap between FMS and chronic fatigue syndrome, and some support for the theory that they form a continuum of one condition.
Female predominance - during premenstrual portion of the cycle, there is a substantial increase in conversion of tryptophane to kynurenine, so it doesn't go to serotonin and leads to increased sleep disturbance. It is postulated that this estrogen dependent shift in tryptophane metabolism is a feature in the female predominance of FMS.
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