Francisco J. Cano-García

Oxidative Stress Correlates with Headache Symptoms in Fibromyalgia: Coenzyme Q10 Effect on Clinical Improvement

Background Fibromyalgia (FM) is a chronic pain syndrome with unknown etiology and a wide spectrum of symptoms such as allodynia, debilitating fatigue, joint stiffness and migraine. Recent studies have shown some evidences demonstrating that oxidative stress is associated to clinical symptoms in FM of fibromyalgia. We examined oxidative stress and bioenergetic status in blood mononuclear cells (BMCs) and its association to headache symptoms in FM patients. The effects of oral coenzyme Q10 (CoQ10) supplementation on biochemical markers and clinical improvement were also evaluated. Methods We studied 20 FM patients and 15 healthy controls. Clinical parameters were evaluated using the Fibromyalgia Impact Questionnaire (FIQ), visual analogues scales (VAS), and the Headache Impact Test (HIT-6). Oxidative stress was determined by measuring CoQ10, catalase and lipid peroxidation (LPO) levels in BMCs. Bioenergetic status was assessed by measuring ATP levels in BMCs. Results We found decreased CoQ10, catalase and ATP levels in BMCs from FM patients as compared to normal control (P<0.05 and P<0.001, respectively) We also found increased level of LPO in BMCs from FM patients as compared to normal control (P<0.001). Significant negative correlations between CoQ10 or catalase levels in BMCs and headache parameters were observed (r = −0.59, P<0.05; r = −0.68, P<0.05, respectively). Furthermore, LPO levels showed a significant positive correlation with HIT-6 (r = 0.33, P<0.05). Oral CoQ10 supplementation restored biochemical parameters and induced a significant improvement in clinical and headache symptoms (P<0.001). Discussion The results of this study suggest a role for mitochondrial dysfunction and oxidative stress in the headache symptoms associated with FM. CoQ10 supplementation should be examined in a larger placebo controlled trial as a possible treatment in FM.

Clinical Symptoms in Fibromyalgia Are Better Associated to Lipid Peroxidation Levels in Blood Mononuclear Cells Rather than in Plasma

Background We examined lipid peroxidation (LPO) in blood mononuclear cells (BMCs) and plasma, as a marker of oxidative damage, and its association to clinical symptoms in Fibromyalgia (FM) patients. Methods We conducted a case–control and correlational study comparing 65 patients and 45 healthy controls. Clinical parameters were evaluated using the Fibromyalgia Impact Questionnaire (FIQ), visual analogues scales (VAS), and the Beck Depression Inventory (BDI). Oxidative stress was determined by measuring LPO in BMCs and plasma. Results We found increased LPO levels in BMCs and plasma from FM patients as compared to normal control (P<0.001). A significant correlation between LPO in BMCs and clinical parameters was observed (r = 0.584, P<0.001 for VAS; r = 0.823, P<0.001 for FIQ total score; and r = 0.875, P<0.01 for depression in the BDI). We also found a positive correlation between LPO in plasma and clinical symptoms (r = 0.452, P<0.001 for VAS; r = 0.578, P<0.001 for FIQ total score; and r = 0.579, P<0.001 for depression in the BDI). Partial correlation analysis controlling for age and BMI, and sex, showed that both LPO in cells and plasma were independently associated to clinical symptoms. However, LPO in cells, but not LPO in plasma, was independently associated to clinical symptoms when controlling for depression (BDI scores). Discussion The results of this study suggest a role for oxidative stress in the pathophysiology of fibromyalgia and that LPO in BMCs rather than LPO in plasma is better associated to clinical symptoms in FM.

Coenzyme Q10: A novel therapeutic approach for Fibromyalgia? Case series with 5 patients

Coenzyme Q(10) (CoQ(10)) is an essential electron carrier in the mitochondrial respiratory chain and a strong antioxidant. Low CoQ(10) levels have been detected in patients with Fibromyalgia (FM). The purpose of the present work was to assess the effect of CoQ(10) on symptoms of five patients with FM. Patients were evaluated clinically with Visual Analogical Scale of pain (VAS), and Fibromyalgia Impact Questionnaire (FIQ). Patients with CoQ(10) deficiency showed a statistically significant reduction on symptoms after CoQ(10) treatment during 9 months (300 mg/day). Determination of deficiency and consequent supplementation in FM may result in clinical improvement. Further analysis involving more scientifically rigorous methodology will be required to confirm this observation.

Factor structure of the Spanish version of the Life Orientation Test-Revised (LOT-R): Testing several models

Studies of the dimensionality of the Life Orientation Test-Revised (LOT-R), considered as the gold standard in the measurement of dispositional optimism, yield controversial results due to the various factorial solutions found. Consequently, the factorial structure of the test has not yet been fully established. The aim of this study is to determine the factorial structure of the LOT-R by comparing seven previous models and their empirical evidence. The test was administered to 906 Spanish participants, ages 18 to 61 (mean age: 23; 56% males). Confirmatory factor analyses were conducted using polychoric correlations. Considering the theoretical background and the best model fit indices (RMSEA=.038; CFI=.98), we conclude that the test presents a factorial structure of a second-order factor (life orientation) composed of two factors (optimism and pessimism). Thus, we recommend using a single global score that could be referred to as life orientation but which ultimately represents the level of dispositional optimism.

Effect of coenzyme Q10 evaluated by 1990 and 2010 ACR Diagnostic Criteria for Fibromyalgia and SCL-90-R: Four case reports and literature review

Recently, Coenzyme Q10 (CoQ10) deficiency has been implicated in the pathophysiology of fibromyalgia (FM). It is our objective to present the findings of the FM evaluation before and after oral CoQ10 treatment using the American College of Rheumatology (ACR) Diagnostic Criteria of 1990 and 2010, and Symptom Checklist-Revised (Scl-90-R). Four patients with FM were examined using the trigger points, the Fibromyalgia Impact Questionnaire, visual analog scale (pain, fatigue, and sleep), Widespread Pain Index, symptom severity scale, and Scl-90-R. Previously, CoQ10 contents from patients were analyzed by high-performance liquid chromatography. All patients showed CoQ10 deficiency. All patients meet the ACR 1990 and 2010 criteria. After treatment, all patients showed an important improvement in clinical symptoms in all evaluation methods. According to our results, and evaluated by three methods, patients with FM are candidates for treatment with CoQ10. However, more controlled clinical trials and investigations are needed to clarify the precise mechanism(s) by which CoQ10 may contribute in pathological and therapeutic processes of FM and to provide data on its effectiveness in FM.

A Shortened Version of the Headache-Specific Locus of Control Scale in Spanish Population

(Headache 2010;50:1335‐1345)

Locus of control patterns in headaches and chronic pain

BACKGROUND Locus of control (LOC) is related to the impact of headaches and chronic pain; however, literature evidence regarding LOC is not always consistent. Several authors consider this to be due, in part, to the separate interpretation of LOC factors, during which the interaction among them is ignored. In 1982, Wallston and Wallston proposed eight possible LOC health patterns depending on whether the individual scored high or low in each of three dimensions. OBJECTIVE To identify these LOC patterns in patients with headaches and chronic pain, and to validate them in terms of their association with a selection of the main pain indicators. METHODS A total of 228 individuals were recruited at three public centres in Seville, Spain. Participants completed a semistructured clinical interview and several questionnaires assessing psychological variables related to pain. The main statistical analyses used were two-step cluster analysis and ANCOVA. RESULTS The six-cluster solution was optimal. The patterns observed coincided with: the believer in control; the yea-sayer; the pure chance; the pure internal; the pure professional; and the nay-sayer clusters. The double external or type VI clusters were not observed. Clusters could be classified from the best to the worst adjustment to chronic pain. CONCLUSIONS These results support the empirical validity of the theoretical model of LOC patterns proposed in 1982 by Wallston and Wallston among a chronic pain population. The analysis of patterns provides more accurate information regarding the adjustment to pain compared with analysis of the LOC factors separately.

Evaluation of a psychological intervention for patients with chronic pain in primary care

According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13–14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program.

The effect of coenzyme Q10 on symptoms of mother and son with fibromyalgia syndrome

Centro Andaluz de Biología del Desarrollo (CABD), Universidad Pablo de Olavide-CSIC and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Sevilla, Spain, Dpto. Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain, Dpto. de Personalidad, Evaluación y Tratamiento Psicológicos, Facultad de Psicología Universidad de Sevilla, Sevilla, Spain, Dpto. de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain, Distrito Sanitario Sevilla Sur, Sevilla, Spain

Body fat and metabolic age as indicators of inflammation and cardiovascular risk

Dear Editor Prevention of cardiovascular disease and its high mortality rates continues to be a challenge worldwide. Obesity is one of the main risk factors, but some data suggest it exerts a protective effect in some patients; this is called the obesity paradox. One of the problems is the tool used to measure obesity. Body mass index (BMI) is the most widely measured parameter, although it cannot be considered an independent predictor of mortality. A higher amount of body fat is related to a proinflammatory state. New data regarding the innate immune response establish the important role of the inflammasome, a multiprotein oligomer activated by Damage-Associated Molecular Patterns and Pathogen-Associated Molecular Patterns that induces production of one or more caspases, leading to the process and secretion of pro-inflammatory cytokines, mainly IL-1b. Obesity activates inflammation through NLRP3 inflammasome recognizing the lipotoxicity-associated ceramide and induces caspase-1 cleavage in macrophages and adipose tissue. Recently, its implication of inflammasome in the development of cardiovascular diseases has been highlighted. We performed a study with 69 male patients, without history of acute coronary episodes, and correlated anthropometric data with cardiovascular risk scores (Fuster BEWAT Score (FBS) and Framingham Risk Score (FRS)) and IL-1b levels. The study protocol and procedures were approved by the Seville University Ethics Committee. The participants gave written informed consent. Body fat and metabolic age were registered with bioimpedance (Tanita SC-330 Body Composition Analyzer, Tanita Corp., Tokyo, Japan). IL-1b was measured with the ELISA test (Biosource). Pearson correlation test was used to correlate body fat and metabolic age with FBS, FRS and IL-1b. For our analysis, we selected two groups of patients: one with a metabolic age more than 15 years above their real age (MMA; n1⁄4 28) and the other with metabolic age below their real age (BMA; n1⁄4 17). Comparisons were made with Snedecor F distribution and Mann–Whitney U test. Results showed a positive correlation between body fat and IL-1b levels and FRS, and negative correlation with FBS (Table 1). MMA had higher values of IL-1b and FRS and lower values of FBS, reaching statistical significance for IL-1b and FBS (Table 2). Our study demonstrates that two anthropometric measurements, body fat and metabolic age, other than BMI, and a new inflammatory parameter, the inflammasome, are related to two validated cardiovascular risk scores. These data suggest that obesity and inflammation could have synergistic effects as cardiovascular risk factors. Body fat and metabolic age are as easy to measure as blood pressure. The best way to evaluate fat as a risk factor is by measuring the epicardial fat and other visceral fat, but it requires sophisticated and expensive medical equipment used just by specialists and impractical to be used by the general population. We suggest that impedance could be incorporated into cardiovascular risk evaluation, especially in epidemiological studies and as regular patients’ control. Our results should be validated with more studies.