Inflammation And Fibromyalgia

When the tissues of the body are injured due to an accident, trauma or infection, the normal response of the body is to provide additional blood flow and protective elements to the injured tissue. It is a natural part of the immune system and is not the same as infection but rather a result of an infection, which is a bacterial or viral attack on the tissues of the body. When the body rushes additional blood for healing to the site of the tissue injury there are some typical symptoms. These include swelling of the tissue, color changes, heat, pain to the tissue surrounding the injury and also a decrease in the movement or functioning of that specific tissue. This is known as acute inflammation, and it typically recedes as soon as the stimulus, the injury, is no longer problematic.

A good example of effective acute inflammation occurs when you get a sliver. The tissues in the skin signal that there is a foreign object or some type of irritant present. This is done by the object triggering receptors on the cells that recognize they are not of the body. These cells release inflammatory mediators that trigger increased blood flow to the area through a process know as vasodilatation. This produces the heat and redness and also, because the blood vessels become more permeable, increased leakage or proteins from the blood into the tissue. This results in the swelling around the sliver.

If the sliver is in the finger, the pain causes a response if you try to use the finger or apply pressure. The building heat, blood flow and swelling in turn forces the foreign object, the sliver, out of the body and allows healing to begin. This process also triggers the immune system that deals with any infection, as well as being the clotting and coagulating process of the wound itself.

When chronic inflammation occurs, the body is not able to stop the initial response of the body to the irritant and the processes continue without the counterbalance to promote healing and recovery. This means that the immune system is compromised and muscle growth and healing cannot and will not occur while chronic inflammation is present.

Cytokines And The Immune Response

Different cells in the body control different aspects of the inflammation process as well as the immune functioning. One important chemical in the system that allows messages to be transferred from immune cells to each other are cytokines. These chemicals are released by the immune system to tell cells to turn on or off or to grow or die. In the case of many autoimmune disorders, changes in cytokine levels are associated with fatigue, achiness, fever and pain.

Research has linked several different specific cytokines to fibromyalgia. Two found to be high in fibromyalgia patients in one study were proinflammatory cytokines interleukin IL-8 and tumor necrosis factor-α (TNF-α). Research found that multidisciplinary pain therapy over a six month period modified the levels of these cytokines, but it did not lead to a direct decrease in the amount of pain experienced by individuals with fibromyalgia. Instead researchers reported that the role of these cytokines is indirectly linked to pain. 1

Other research, including a study of 80 patients with fibromyalgia, also indicated elevated cytokine levels in the body. In this study higher levels of IL-10, IL-8 and TNF-alpha were found in fibromyalgia patients than in controls, and they could be used as specific markers of elevated inflammatory responses in the body.  This study also compared the results to the patient’s psychiatric profiles and found that different profile produced the same results, leading to a definite link of inflammatory response system impairment and the diagnosis of fibromyalgia. 2

Yet other research is looking into the role of substance P, a pain messenger, which is found in elevated levels in individuals with fibromyalgia. Substance P is produced by cytokines, but efforts to identify the specific genes responsible for the elevated substance P levels have not yet developed any specific identifiable markers. 3

Leaky Gut

Leaky gut refers to a condition where the permeability of the intestines and bowels is higher than found in individuals that do not have the condition. It occurs when mucosal integrity is not maintained through the system and may be a result of abnormal intestinal microbiota, all which are found in a variety of different health issues including type 1 diabetes.

Researchers have linked leaky gut to increased risk of inflammatory cytokine activity in the body that may lead to chronic heart failure, chronic inflammatory disease of the liver, hepatic inflammatory disorders and autoimmune disorders. It has also been linked to chronic fatigue syndrome where correction of the permeability of the intestines and bowels has lead to an improvement in symptoms for some individuals.

In one study that attempted to evaluate the connection of pain levels in patients with fibromyalgia and the specific degree of small intestinal bacterial overgrowth associated with leaky gut, interesting results were uncovered. Researchers found that those patients with fibromyalgia had higher intestinal permeability levels than the control group. Both patients with fibromyalgia and those with complex regional pain syndrome showed the same types of increases in intestinal permeability, suggesting a possible similarly in factors leading to the development of these types of syndromes.

Leaky gut is treated through the use of NAIDS or natural anti-inflammatory/anti-oxidative substances. Probiotics and the introduction of healthy bacteria to the diet may also provide the necessary changes to allow intestinal permeability to decrease.

Berberine, which is an ammonium salt found in some plants, can also be used as a natural treatment. Common plants associated with Berberine include the Oregon grape, Barberry, Californian Poppy and Goldenseal. In vitro tests of the use of Berberine in intestinal epithelial cells show that it does prevent the action of pro-inflammatory cytokines and restores the natural barrier function of the intestines if they are in a diseased state. 4

While this research suggests that inflammation may play a role in fibromyalgia, there has been no evidence that anti-inflammatory medications help patients with fibromyalgia. Most research has shown that anti-inflammatory medications are no more beneficial than placebo. Therefore, most doctors do not recommend using anti-inflammation medications in the treatment of fibromyalgia.


1 Wang, H., Moser, M., Schiltenwolf, M., et al. (2008). Circulating Cytokine Levels Compared to Pain in Patients with Fibromyalgia — A Prospective Longitudinal Study Over 6 Months. The Journal of Rheumatology , 1366-1370.

2 Bazzichi, L., Rossi, a., Massimetti, G., et al. (2007). Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clinical and Experimental Rheumatology , 225-230.

3 Ablin, J. N., Bar-Shira, A., Yaron, M., et al. (2009). Candidate-gene approach in fibromyalgia syndrome: association analysis of the genes encoding substance P receptor, dopamine transporter and α1-antitrypsin. Clinical and Experiemental Rheymatology , S33-S38.

4 Li, N., Gu, L., Qu, L.,et al. (2010). Berberine attenuates pro-inflammatory cytokine-induced tight junction disruption in an in vitro model of intestinal epithelial cells. European Journal of Pharmaceutical Sciences , 1-8.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015