Immune-Pineal Axis Function in Fibromyalgia

Overview

Fibromyalgia is a common condition in clinical medical practice, characterized by diffuse musculoskeletal pain. Sleep disorders, chronic fatigue, depression, intestinal disorders and headache are also commonly associated with the syndrome . Although the etiology of this syndrome is not well defined yet, it means involve multiple mechanisms, including low levels of serotonin, increased substance P in cerebrospinal fluid and altered circadian variation in sympathetic – parasympathetic balance, consistent with changes in sympathetic hyperactivity at night . The immune – pineal system, formed by the integration of the adrenergic and immune systems pineal gland, appears to be involved in the genesis of the dysfunctions found in fibromyalgia. Melatonin is secreted by the pineal gland and has promoter activity of sleep. Studies show that melatonin and its precursors , serotonin and tryptophan are reduced in patients with fibromyalgia. The present study aims to evaluate the relationship of immune – pineal system in the process of fibromyalgia , since dysfunction of this axis appears to govern the cascading events that participate in the pathophysiological process of this disease.

Full Title of Study: “Phase II Role of Immune-pineal Axis in Fibromyalgia: Noradrenergic Modulation and Chronotherapeutic Aspects”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Triple (Participant, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: January 2014

Interventions

  • Drug: Melatonin and Placebo
  • Drug: Amitriptyline and Placebo
  • Drug: Melatonin and Amitriptylin

Arms, Groups and Cohorts

  • Experimental: Melatonin and Placebo
    • Melatonin 10mg and placebo, once in the evening, for 6 weeks.
  • Experimental: Amitriptyline and placebo
    • Amitriptyline 25mg and placebo, once in the evening, for 6 weeks.
  • Active Comparator: Melatonin and Amitriptylin
    • Melatonin 10mg and Amitriptylin 25mg, once in the evening, for 6 weeks.

Clinical Trial Outcome Measures

Primary Measures

  • Change from Baseline in pain on Fibromyalgia Impact Questionnaire (FIQ) at week 6
    • Time Frame: Baseline, week 6
  • Change from Baseline in Pain Pressure Threshold (PPT) at week 6
    • Time Frame: Baseline, week 6
    • Pain Pressure Threshold by Fischer algometer on the tender points.
  • Change from Baseline Brain-derived neurotrophic factor at week 6
    • Time Frame: Baseline, week 6

Secondary Measures

  • Change from Baseline of the Pittsburgh Sleep Quality Index (PSQI) at week 6
    • Time Frame: Baseline, week 6
  • Change from Baseline of the Pain Catastrophizing Scale at week 6
    • Time Frame: Baseline; week 6
    • Catastrophic thinking related to pain

Participating in This Clinical Trial

Inclusion Criteria

  • Women 18-65 years old – Fibromyalgia according to the criteria of the American College of Rheumatology (Wolfe 2010) – Sign the informed consent – Patients can take medication for chronic pain ( antidepressants , antiepileptics, for example), since there are at least two months Exclusion criteria:

  • patients who did not understand the Portuguese – diagnosis of malignancies, severe psychiatric disorders , sleep disorders not related to fibromyalgia (apnea , sleepwalking , restless leg syndrome), Alzheimer's disease or any disease (rheumatologic, neurological, etc.) that can modify the evaluations or outcomes – alcohol abuse or drug addiction – patients who are performing acupuncture – BMI greater than 35 ( BMI = body mass index) . – Patients with history of allergy to amitriptyline or/and melatonin or any other contraindication for the use of these drugs

Gender Eligibility: Female

Minimum Age: 18 Years

Maximum Age: 65 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hospital de Clinicas de Porto Alegre
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Wolnei d Caumo, PhD, Study Director, Hospital de Clinicas de Porto Alegre
  • Overall Contact(s)
    • Wolnei Caumo, PhD, 555133598083, caumo@cpovo.net

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