phosphocreatine and Fibromyalgia

The presence of abnormalities in fibromyalgia muscle using current methodological approaches is well established. The more serious abnormalities are demonstrated by histologic studies particularly on electron microscopy: disorganisation of Z bands and abnormalities in the number and shape of mitochondria. Biochemical studies and P 31 magnetic resonance spectroscopy show inconstant abnormalities of ATP and phosphocreatine levels. Mitochondrial abnormalities reduced capillary circulation and thickened capillary endothelium may result in decreased availability of oxygen and impaired oxidative phosphorylation as well as ATP synthesis. These abnormalities do not seem to be the consequences of the much-discussed deconditioning of muscles although these consequences are not well known. Further studies of energy metabolism of the muscle during exercise are needed.

Topics: Adenosine Triphosphate; Endothelium, Vascular; Energy Metabolism; Fibromyalgia; Humans; Microcirculation; Microscopy, Electron; Mitochondria, Muscle; Muscle, Skeletal; Muscular Diseases; Pain; Phosphocreatine

Widespread muscle pain and tender points are the most common complaints of fibromyalgia patients, and the underlying mechanisms responsible for these symptoms have been studied intensively during the past decade. It has been suggested that fatigue and pain may lead to decreased levels of physical activity in many patients. The resulting deconditioned state may itself contribute to muscle abnormalities. Associated symptoms such as disturbed sleep, anxiety, depression, or irritable bowel also may have a negative impact on muscle function and level of daily activities. The important interactions between the central nervous and musculoskeletal systems may involve another element, the neuroendocrine stress-response system. This review will consider both the current state of knowledge and also future studies which might be designed to answer more effectively the outstanding questions regarding the underlying pathogenesis of fibromyalgia.

Topics: Adenosine Triphosphate; Biomechanical Phenomena; Energy Metabolism; Fibromyalgia; Humans; Models, Biological; Muscle, Skeletal; Musculoskeletal Diseases; Pain; Phosphocreatine; Physical Endurance

In Sweden, several studies have been performed in patients with fibromyalgia to study muscle morphology, chemistry and physiology in order to understand the origin of the most prominent symptoms in fibromyalgia: muscle pain, muscle fatigue and muscle stiffness. These studies have shown changes indicating disturbed microcirculation, mitochondrial damage and a reduced content of high energy phosphates. Thus, there may be an energy deficiency state in the resting painful muscle in fibromyalgia. Pain analysis has supported the idea that there is a nociceptive origin of the pain. Our hypothesis is that any condition that could lead to constant muscle hypoxia, e.g., through establishment of abnormal motor patterns, might be a possible cause of fibromyalgic pain.

Topics: Adenosine Triphosphate; Biopsy; Connective Tissue; Fibromyalgia; Humans; Microcirculation; Models, Biological; Muscles; Pain; Pain Measurement; Phosphocreatine

To investigate the efficacy and safety of creatine supplementation in fibromyalgia patients.. A 16-week, randomized, double-blind, placebo-controlled, parallel-group trial was conducted. Fibromyalgia patients were randomly assigned to receive either creatine monohydrate or placebo in a double-blind manner. The patients were evaluated at baseline and after 16 weeks. Muscle function, aerobic conditioning, cognitive function, quality of sleep, quality of life, kidney function, and adverse events were assessed. Muscle phosphorylcreatine content was measured through (31) P magnetic resonance spectroscopy.. After the intervention, the creatine group presented higher muscle phosphorylcreatine content when compared with the placebo group (+80.3% versus -2.7%; P = 0.04). Furthermore, the creatine group presented greater muscle strength than the placebo group in the leg press and chest press exercises (+9.8% and +1.2% for creatine versus -0.5% and -7.2% for placebo, respectively; P = 0.02 and P = 0.002, respectively). Isometric strength was greater in the creatine group than in the placebo group (+6.4% versus -3.2%; P = 0.007). However, no general changes were observed in aerobic conditioning, pain, cognitive function, quality of sleep, and quality of life. Food intake remained unaltered and no side effects were reported.. Creatine supplementation increased intramuscular phosphorylcreatine content and improved lower- and upper-body muscle function, with minor changes in other fibromyalgia features. These findings introduce creatine supplementation as a useful dietary intervention to improve muscle function in fibromyalgia patients.

Topics: Adult; Creatine; Dietary Supplements; Double-Blind Method; Female; Fibromyalgia; Humans; Middle Aged; Phosphocreatine

31phosphorus nuclear magnetic resonance (31P NMR) spectroscopy of painful calf muscle was performed in 12 patients with fibromyalgia and 7 healthy subjects during rest, aerobic and anaerobic exercising conditions, and postexercise recovery. Ratios of inorganic phosphate and creatine phosphate (Pi/PCr) and pH were calculated from the collected 31P NMR spectra. Resting values of Pi/PCr were normal in the patients. Patients only tolerated 49% of the workload tolerated by the controls (P = 0.005). Patients and controls had similar rates of Pi/PCr and pH changes during work and recovery. The controls were able to change their Pi/PCr and pH more than the patients, due to the greater workload reached. However, statistical significance was only reached for the anaerobic static exercise (P = 0.003). It was concluded that fibromyalgia patients have a reduced voluntary capacity for work, but with a biochemical response to work and recovery similar to healthy subjects.

Topics: Adult; Cross-Sectional Studies; Exercise; Female; Fibromyalgia; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Phosphates; Phosphocreatine; Phosphorus; Rest

To measure inorganic phosphate (Pi), phosphocreatine (PCr), ATP and phosphodiesters (PDE) in fibromyalgic muscle tissue by (31)P magnetic resonance spectroscopy.. A 1.5 Tesla scanner with a P 100 surface coil was used to examine 15 patients (mean age 49.9+/-14.3 yr) with fibromyalgia, according to the American College of Rheumatology criteria, and 17 healthy controls (mean age 30.2+/-5.8 yr).. Compared with the controls, there were increases in the levels of PDE (+22%, P = 0.032) and Pi (+19%, P = 0.019) in the spectra of fibromyalgia patients, but there was no difference in pH.. The metabolic differences we found may have been related to weakness and fatigue in the fibromyalgia patients, but they do not fully explain the fibromyalgia symptoms.

Topics: Adenosine Triphosphate; Adult; Ethanolamines; Female; Fibromyalgia; Glycerylphosphorylcholine; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Muscle, Skeletal; Nucleosides; Phosphates; Phosphatidylethanolamines; Phosphocreatine; Phosphorus; Phosphorylcholine; Reference Values

To investigate the metabolic and functional status of muscles of fibromyalgia (FM) patients, using P-31 magnetic resonance spectroscopy (MRS).. Twelve patients with FM and 11 healthy subjects were studied. Clinical status was assessed by questionnaire. Biochemical status of muscle was evaluated with P-31 MRS by determining concentrations of inorganic phosphate (Pi), phosphocreatine (PCr), ATP, and phosphodiesters during rest and exercise. Functional status was evaluated from the PCr/Pi ratio, phosphorylation potential (PP), and total oxidative capacity (Vmax).. Patients with FM reported greater difficulty in performing activities of daily living as well as increased pain, fatigue, and weakness compared with controls. MRS measurements showed that patients had significantly lower than normal PCr and ATP levels (P < 0.004) and PCr/Pi ratios (P < 0.04) in the quadriceps muscles during rest. Values for PP and Vmax also were significantly reduced during rest and exercise.. P-31 MRS provides objective evidence for metabolic abnormalities consistent with weakness and fatigue in patients with FM. Noninvasive P-31 MRS may be useful in assessing clinical status and evaluating the effectiveness of treatment regimens in FM.

Topics: Adenosine Triphosphate; Adult; Fatigue; Female; Fibromyalgia; Health Status; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Muscle Weakness; Muscle, Skeletal; Pain; Phosphates; Phosphocreatine; Phosphorus; Physical Exertion; Self-Assessment; Thigh

Topics: Adenosine Triphosphate; Energy Metabolism; Fibromyalgia; Humans; Magnetic Resonance Spectroscopy; Muscles; Phosphocreatine

To determine if patients with fibromyalgia syndrome (FMS) are more susceptible to activity-induced muscle damage than are healthy subjects.. Eleven FMS patients and 10 healthy subjects performed concentric and eccentric exercise with their dominant and nondominant forearms, respectively. 31P magnetic resonance spectroscopy (to assess inorganic phosphate [P(i)] and phosphocreatine [PCr]) and dolorimetry (to assess pain) were performed before and 20 minutes after exercise and at 4 subsequent 24-hour intervals.. Neither group exhibited increased P(i)/PCr ratios or reduced dolorimetry scores following the exercise protocols. FMS patients did display a phosphodiester resonance at a higher rate than healthy subjects (37% versus 12%), but this was not related to the exercise.. Unchanged P(i)/PCr ratios and dolorimetry scores following acute exercise provide evidence against the hypothesis that FMS patients are more susceptible to activity-induced muscle damage than are healthy subjects, although P(i)/Pcr and pain may not adequately document such damage. The frequent occurrence of phosphodiester in the spectra of FMS patients may indicate a sarcolemmal abnormality in these subjects.

Topics: Adult; Exercise; Fibromyalgia; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Muscles; Pain Measurement; Phosphates; Phosphocreatine; Phosphorus Isotopes

Erythrocyte transketolase activity coefficient (ETK-AC) and affinity for coenzyme (Km TPP) were assessed in 50 patients with transketolase abnormalities such as fibromyalgia or senile dementia of Alzheimer's type, before and after magnesium (Mg), thiamin+pyridoxine (B1,B6), high energy phosphates (HEP) (phosphocreatinine of adenosine triphosphate), and piracetam. Compared to 12 untreated patients, ETK-AC was significantly decreased with B1,B6 (P < 0.05, n = 10); Km-TPP was significantly decreased with HEP (P < 0.05, n = 20) and piracetam (P < 0.01, n = 5). In nine other patients treated with HEP + B1,B6 + magnesium, ETK-AC and Km TPP were both significantly decreased.

Topics: Adenosine Triphosphate; Aged; Aged, 80 and over; Alzheimer Disease; Erythrocytes; Female; Fibromyalgia; Humans; Kinetics; Magnesium; Male; Middle Aged; Phosphocreatine; Piracetam; Retrospective Studies; Thiamine; Transketolase

The fields of muscle physiology and biochemistry have already identified some of the key components of ATPase hydrolysis products that are involved in muscle fatigue. The concentration of the relevant chemical species can be readily measured by nuclear magnetic resonance techniques in muscle. Now the question is: is alteration of cellular energy balance and the normal balance between supply and demand disturbed in fibromyalgia? Since these chemical events account for a very large amount of muscle reduced performance as well as reduction in both velocity and force, at the very least one ought to identify how large these changes are in any patient in whom we are trying to assess the degree to which these chemical changes might be associated with muscle fatigue. An objective chemical criteria for muscle performance is possible with modern noninvasive phosphorus magnetic resonance spectroscopy.

Topics: Adenosine Triphosphate; Biomechanical Phenomena; Creatine Kinase; Energy Metabolism; Exercise; Fibromyalgia; Humans; Magnetic Resonance Spectroscopy; Models, Biological; Muscles; Phosphocreatine; Reference Values