Other: Does viral suppression therapy enhance pain control in selected fibromyalgia patients?

Abstract

Some cases of fibromyalgia demonstrate severe, persistent pain which is difficult to control even with high dosages of opioid drugs. To date there is neither standard therapy for fibromyalgia nor accepted causation, although viral infection has been postulated as a possible cause of some cases. Seven fibromyalgia patients who had experienced numerous symptomatic treatments and were maintained with opioids at 400 - 1000mg/dl of morphine equivalence were studied. Pain control was judged to be poor to fair. Subjects demonstrated positive serum titers at least two times normal to two or more of the following viral agents: (1) cytomegalus; (2) rubella; (3) varicella; (4) herpes simplex; (5) Ebstein Barr. Titers indicated either previous or possibly current infection. Patients were treated with either acyclovir, 400 to 1000mg/d, or valacyclovir, 500 to 1000mg/d. After one month patients were evaluated for pain reduction, endurance, well-being, and side-effects. If improved pain control was reported, viral suppression was indefinitely continued. All patients reported improvement in pain control, endurance, energy, and well-being. Two reported decrease in cervical lymph node size. Discontinuation of viral suppression for one week in three patients resulted in a resurgence of pain and other symptoms. This preliminary study suggests that fibromyalgia patients with severe persistent pain and positive viral titers may experience enhanced pain control with viral suppression therapy. It also suggests that there is some unclear neuro-mechanism by which a previous or current viral infection may produce pain.