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Fibromyalgia and obesity: the hidden link

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Abstract

Fibromyalgia is a chronic disorder of uncertain etiology, characterized by widespread pain, muscle tenderness, and decreased pain threshold to pressure and other stimuli. Obesity is a well-known aggravating factor for certain rheumatologic conditions, such as knee osteoarthritis. Emerging evidences are exploring the link between obesity and other rheumatic diseases, such as fibromyalgia. Epidemiological data show that fibromyalgia patients have higher prevalence of obesity (40%) and overweight (30%) in multiple studies compared with healthy patients. Several mechanisms have been proposed to explain “the hidden link”, but at this time is not possible to ascertain whether obesity is cause or consequence of fibromyalgia. Among mechanisms proposed, there are the following: impaired physical activity, cognitive and sleep disturbances, psychiatric comorbidity and depression, dysfunction of thyroid gland, dysfunction of the GH/IGF-1 axis, impairment of the endogenous opioid system. In this article, we review the scientific evidence supporting a possible link between obesity and fibromyalgia, how obesity influences fibromyalgia symptoms and how fibromyalgia severity can be improved by weight loss. In addition, we analyze the possible mechanisms by which fibromyalgia and obesity interrelate.

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References

  1. Wolfe F, Smythe HA, Yunus MB et al (1990) The American college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthr Rheum 33:160–172

    Article  CAS  Google Scholar 

  2. Arnold LM, Hudson JI, Keck PE Jr et al (2006) Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry 67:1219–1225

    Article  PubMed  Google Scholar 

  3. Hudson JI, Pope HG Jr (1996) The relationship between fibromyalgia and major depressive disorder. Rheum Dis Clin North Am 22:285–303

    Article  PubMed  CAS  Google Scholar 

  4. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L (1995) The prevalence and characteristics of fibromyalgia in the general population. Arthr Rheum 38:19–28

    Article  CAS  Google Scholar 

  5. Arnold LM, Hudson JI, Hess EV et al (2004) Family study of fibromyalgia. Arthr Rheum 50:944–952

    Article  Google Scholar 

  6. Walker EA, Keegan D, Gardner G et al (1997) Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. Psychiatric diagnoses and functional disability. Psychosom Med 59:565–571

    PubMed  CAS  Google Scholar 

  7. Hawley DJ, Wolfe F (1991) Pain, disability, and pain/disability relationships in seven rheumatic disorders: a study of 1, 522 patients. J Rheumatol 18:1552–1557

    PubMed  CAS  Google Scholar 

  8. Russell IJ, Vaeroy H, Javors M, Nyberg F (1992) Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis. Arthr Rheum 35:550–556

    Article  CAS  Google Scholar 

  9. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Javors MA, Bowden CA (1992) Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol 19:104–109

    PubMed  CAS  Google Scholar 

  10. Yunus MB, Dailey JW, Aldag JC, Masi AT, Jobe PC (1992) Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study. J Rheumatol 19:90–94

    PubMed  CAS  Google Scholar 

  11. Schwarz MJ, Spath M, Muller-Bardorff H, Pongratz DE, Bondy B, Ackenheil M (1999) Relationship of substance P 5-hydroxyindole acetic acid and tryptophan in serum of fibromyalgia patients. Neurosci Lett 259:196–198

    Article  PubMed  CAS  Google Scholar 

  12. Basbaum AI, Fields HL (1984) Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Annu Rev Neurosci 7:309–338

    Article  PubMed  CAS  Google Scholar 

  13. Clark FM, Proudfit HK (1993) The projections of noradrenergic neurons in the A5 catecholamine cell group to the spinal cord in the rat: anatomical evidence that A5 neurons modulate nociception. Brain Res 616:200–210

    Article  PubMed  CAS  Google Scholar 

  14. Millian MJ (2002) Descending control of pain. Prog Neurobiol 66:355–474

    Article  Google Scholar 

  15. Garrow JS (1988) Obesity and related diseases. Churchill Livingstone, London, pp 1–16

  16. Peltonen M, Lindroos AK, Torgerson JS (2003) Musculoskeletal pain in the obese: a comparison with a general population and longterm changes after conventional and surgical obesity treatment. Pain 104:549–557

    Article  PubMed  Google Scholar 

  17. Bingfors K, Isacson D (2004) Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain—a gender perspective. Eur J Pain 8:435–450

    Article  Google Scholar 

  18. Felson DT, Zhang Y, Anthony JM, Naimack AA, Anderson JJ (1992) Weight loss reduces the risk for symptomatic knee osteoarthritis in women. Ann Int Med 116:535–539

    PubMed  CAS  Google Scholar 

  19. Christensen R, Astrup A, Bliddal H (2005) Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cart 13:20–27

    Article  CAS  Google Scholar 

  20. Gelber S, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ (2005) Knee osteoarthritis and body mass index: a population-based case–control study. Scand J Rheumatol 34:59–64

    Article  Google Scholar 

  21. Carman WJ, Sowers M, Hawthorne VM, Weissfeld LA (1994) Obesity as a risk factor for osteoarthritis of the hand and wrist: a prospective study. Am J Epidemiol 139(2):119–129

    PubMed  CAS  Google Scholar 

  22. Stallings SP, Kasdan ML, Sorgel TM, Corwin HM (1997) A case–control study of obesity as a risk factor for carpal tunnel syndrome in a population of 600 patients presenting for independent medical exam. J Hand Surg 22:211–215

    Article  CAS  Google Scholar 

  23. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R (2004) Risk factors in carpal tunnel syndrome. J Hand Surg 29:315–320

    CAS  Google Scholar 

  24. Becker J, Nora DB, Gomes I, Stringari R, Panosso JS, Ehlers JC (2002) An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 13:1429–1434

    Article  Google Scholar 

  25. Han TS, Schouten JS, Seidell JC (1997) The prevalence of low-back pain and association with body fatness, fat distribution and height. Int J Obes Relat Metab Disord 21:600–607

    Article  PubMed  CAS  Google Scholar 

  26. Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L (2007) An internet survey of 2, 596 people with fibromyalgia. BMC Musculoskelet Disord 8:27

    Article  PubMed  Google Scholar 

  27. US Census Bureau: United States Census 2000. http://www.census.gov/main/www/cen2000.html. (Electronic Citation2000)

  28. Neumann L, Lerner E, Glazer Y, Bolotin A, Shefer A, Buskila D (2008) A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients. Clin Rheumatol 27(12):1543–1547

    Article  PubMed  Google Scholar 

  29. Okifuji A, Bradshaw DH, Olson C (2009) Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions. Clin Rheumatol 28(4):475–478

    Article  PubMed  Google Scholar 

  30. Saber AA, Boros MJ, Mancl T, Elgamal MH, Song S, Wisadrattanapong T (2008) The effect of laparoscopic Roux-en-Y gastric bypass on fibromyalgia. Obes Surg 18(6):652–655

    Article  PubMed  Google Scholar 

  31. Wahner-Roedler DL, Olson EJ, Narayanan S, Sood R, Hanson AC, Loehrer LL, Sood A (2007) Gender-specific differences in a patient population with obstructive sleep apnea-hypopnea syndrome. Gend Med 4(4):329–338

    Article  PubMed  Google Scholar 

  32. Chaiamnuay S, Bertoli AM, Fernández M, Apte M, Vilá LM, Reveille JD, Alarcón GS; LUMINA Study Group (2007) The impact of increased body mass index on systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA XLVI) [corrected]. J Clin Rheumatol 13(3):128–133. Erratum in: J Clin Rheumatol. 2007 Oct;13(5):302

    Google Scholar 

  33. Yunus MB, Arslan S, Aldag JC (2002) Relationship between body mass index and fibromyalgia features. Scand J Rheumatol 31:27–31

    Article  PubMed  Google Scholar 

  34. Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, Ciapparelli A, Dell’Osso L, Bombardieri S (2007) Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol 25(2):225–230. PubMed PMID: 17543146

    Google Scholar 

  35. Wang H, Moser M, Schiltenwolf M, Buchner M (2008) Circulating cytokine levels compared to pain in patients with fibromyalgia—a prospective longitudinal study over 6 months. J Rheumatol 35(7):1366–1370. Epub 2008 Jun 1. PubMed PMID: 18528959

    Google Scholar 

  36. Shapiro JR, Anderson DA, Danoff-Burg S (2005) A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms. J Psychosom Res 59(5):275–282

    Article  PubMed  Google Scholar 

  37. Brownell KD (1999) The LEARN Program for weight control, 7th edn. American Health Publishing, Dallas (Tex)

    Google Scholar 

  38. Hooper MM, Stellato TA, Hallowell PT, Seitz BA, Moskowitz RW (2007) Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery. Int J Obes (Lond) 31(1):114–120

    Google Scholar 

  39. White KP, Harth M, Speechley M, Ostbye T (1999) Testing an instrument to screen for fibromyalgia syndrome in general population studies: the London fibromyalgia epidemiology study screening questionnaire. J Rheumatol 26:880–884

    Google Scholar 

  40. Henriksson CM (1994) Longterm effects of fibromyalgia on everyday life. A study of 56 patients. Scand J Rheumatol 23(1):36–41

    Google Scholar 

  41. Hawley DJ, Wolfe F, Cathey MA (1988) Pain, functional disability, and psychological status: a 12-month study of severity in fibromyalgia. J Rheumatol 15(10):1551–1556

    Google Scholar 

  42. Watenpaugh DE (2009) The role of sleep dysfunction in physical inactivity and its relationship to obesity. Curr Sports Med Rep 8(6):331–338

    Google Scholar 

  43. St-Onge MP, Perumean-Chaney S, Desmond R, Lewis CE, Yan LL, Person SD, Allison DB (2010) Gender differences in the association between sleep duration and body composition: the cardia study. Int J Endocrinol 2010:726071

    PubMed  Google Scholar 

  44. Algul A, Ates MA, Semiz UB, Basoglu C, Ebrinc S, Gecici O, Gülsün M, Kardesoglu E, Cetin M (2009) Evaluation of general psychopathology, subjective sleep quality, and health-related quality of life in patients with obesity. Int J Psychiatry Med 39(3):297–312

    Article  PubMed  Google Scholar 

  45. Zahorska-Markiewicz B, Zych P, Kucio C (1988) Pain sensitivity in obesity. Acta Physiol Pol 39(3):183–187

    Google Scholar 

  46. Zahorska-Markiewicz B, Kucio C, Pyszkowska J (1983) Obesity and pain. Hum Nutr Clin Nutr 37(4):307–310

    Google Scholar 

  47. Ramzan I, Wong BK, Corcoran GB (1993) Pain sensitivity in dietary-induced obese rats. Physiol Behav 54(3):433–435

    Google Scholar 

  48. Raymond NC, de Zwaan M, Faris PL, Nugent SM, Achard DM, Crosby RD, Mitchell JE (1995) Pain thresholds in obese binge-eating disorder subjects. Biol Psychiatry 37(3):202–204

    Google Scholar 

  49. Gadalla TM (2009) Association of obesity with mood and anxiety disorders in the adult general population. Chronic Dis Can 30(1):29–36

    PubMed  CAS  Google Scholar 

  50. Carette S, Lefrançois L (1988) Fibrositis and primary hypothyroidism. J Rheumatol 15(9):1418–1421

    PubMed  CAS  Google Scholar 

  51. Riedel W, Layka H, Neeck G (1998) Secretory pattern of GH, TSH, thyroid hormones, ACTH, cortisol, FSH, and LH in patients with fibromyalgia syndrome following systemic injection of the relevant hypothalamic-releasing hormones. Z Rheumatol 57(Suppl 2):81–87

    Article  PubMed  CAS  Google Scholar 

  52. Neeck G, Riedel W (1992) Thyroid function in patients with fibromyalgia syndrome. J Rheumatol 19(7):1120–1122

    Google Scholar 

  53. Ribeiro LS, Proietti FA (2004) Interrelations between fibromyalgia, thyroid autoantibodies, and depression. J Rheumatol 31(10):2036–2040

    PubMed  Google Scholar 

  54. Soy M, Guldiken S, Arikan E, Altun BU, Tugrul A (2007) Frequency of rheumatic diseases in patients with autoimmune thyroid disease. Rheumatol Int 27(6):575–577

    Article  PubMed  Google Scholar 

  55. Bazzichi L, Rossi A, Giuliano T, De Feo F, Giacomelli C, Consensi A, Ciapparelli A, Consoli G, Dell’osso L, Bombardieri S (2007) Association between thyroid autoimmunity and fibromyalgic disease severity. Clin Rheumatol 26(12):2115–2120

    Article  PubMed  Google Scholar 

  56. Lowe JC, Yellin J, Honeyman-Lowe G (2006) Female fibromyalgia patients: lower resting metabolic rates than matched healthy controls. Med Sci Monit 12(7):CR282–CR289. Epub 2006 Jun 28

    Google Scholar 

  57. Bennett RM, Clark SR, Campbell SM, Burckhardt CS (1992) Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Arthritis Rheum 35(10):1113-1116

    Google Scholar 

  58. Bennett RM, Cook DM, Clark SR, Burckhardt CS, Campbell SM (1997) Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia. J Rheumatol 24(7):1384–1389

    Google Scholar 

  59. Paiva ES, Deodhar A, Jones KD, Bennett R (2002) Impaired growth hormone secretion in fibromyalgia patients: evidence for augmented hypothalamic somatostatin tone. Arthr Rheum 46(5):1344–1350

    Article  CAS  Google Scholar 

  60. Maccario M, Grottoli S, Procopio M, Oleandri SE, Rossetto R, Gauna C, Arvat E, Ghigo E (2000) The GH/IGF-I axis in obesity: influence of neuro-endocrine and metabolic factors. Int J Obes Relat Metab Disord 24(Suppl 2):S96–S99

    PubMed  CAS  Google Scholar 

  61. Cuatrecasas G, Riudavets C, Güell MA, Nadal A (2007) Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. A pilot study. BMC Musculoskelet Disord 8:119

    Google Scholar 

  62. Okifuji A, Donaldson GW, Barck L, Fine PG (2010) Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. J Pain 11(12):1329–1337

    Article  PubMed  Google Scholar 

  63. Mork PJ, Vasseljen O, Nilsen TI (2010) Association between physical exercise, body mass index, and risk of fibromyalgia: longitudinal data from the Norwegian Nord-Trøndelag health study. Arthr Care Res (Hoboken) 62(5):611–617

    Article  Google Scholar 

  64. Roane DS, Porter JR (1986) Nociception and opioid-induced analgesia in lean (Fa/-) and obese (fa/fa) Zucker rats. Physiol Behav 38:215–218

    Article  PubMed  CAS  Google Scholar 

  65. Kutlu S, Canpolat S, Sandal S, Ozcan M, Sarsilmaz M, Kelestimur H (2003) Effects of central and peripheral administration of leptin on pain threshold in rats and mice. Neuro Endocrinol Lett 24(3–4):193–196

    Google Scholar 

  66. Kawasaki Y, Zhang L, Cheng JK, Ji RR (2008) Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci 28:5189–5194

    Article  PubMed  CAS  Google Scholar 

  67. Dina OA, Green PG, Levine JD (2008) Role of interleukin-6 in chronic muscle hyperalgesic priming. Neuroscience 152:521–525

    Article  PubMed  CAS  Google Scholar 

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Ursini, F., Naty, S. & Grembiale, R.D. Fibromyalgia and obesity: the hidden link. Rheumatol Int 31, 1403–1408 (2011). https://doi.org/10.1007/s00296-011-1885-z

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