Abstract
Central sensitization syndromes are a collection of frequently painful disorders that contribute to decreased quality of life and increased risk of opiate abuse. Although these disorders cause significant morbidity, they frequently lack reliable diagnostic tests. As such, technologies that can identify key moieties in central sensitization disorders may contribute to the identification of novel therapeutic targets and more precise treatment options. The analysis of small molecules in biological samples through metabolomics has improved greatly and may be the technology needed to identify key moieties in difficult to diagnose diseases. In this review, we discuss the current state of metabolomics as it relates to central sensitization disorders. From initial literature review until Feb 2020, PubMed, Embase, and Scopus were searched for applicable studies. We included cohort studies, case series, and interventional studies of both adults and children affected by central sensitivity syndromes. The majority of metabolomic studies addressing a CSS found significantly altered metabolites that allowed for differentiation of CSS patients from healthy controls. Therefore, the published literature overwhelmingly supports the use of metabolomics in CSS. Further research into these altered metabolites and their respective metabolic pathways may provide more reliable and effective therapeutics for these syndromes.
Highlights
It is important to recognize that studies finding differences between two states do not have found biomarkers, but rather differentiating metabolites
We found one metabolomics study each for the conditions low back pain, multiple chemical sensitivity syndrome, dysmenorrhea and restless legs syndrome suggesting that opportunities for discovery exist with all of the aforementioned conditions
Metabolomics has provided promising discoveries with technologies such as vibrational spectroscopy which has led to future potential for biomarker discover in FM and interstitial cystitis
Summary
CFS has been associated with errors in the immune system, central nervous system, autonomic nervous system, and energy metabolism, these findings are not consistent enough to provide satisfactory sensitivity and/or specificity for a diagnostic test for CFS. Another analysis of plasma metabolites assessed 612 metabolites from 63 various biochemical pathways in CFS patients and controls using hydrophilic interaction liquid chromatography, electrospray ionization (ESI), and tandem mass spectrometry (MS/MS) [45,46] The majority of these metabolite concentrations were decreased in CFS patients compared to controls, but significant abnormalities were identified in 20 unique metabolic pathways. These include an increase in pyrroline-5-carboxylate and decreases in sphingolipids, phospholipids, purines, cholesterol, and microbiome amino acids, to name a few. Increased muscle catabolism could further agitate CRPS symptoms and decrease health outcomes
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