My critique of this study:
- Nowhere does it mention how long each participant has had fibro. The longer one has it, the less likely one is to be physically fit one the more likely one is to be overweight (higher BMI). This is a major risk factor in developing prediabetes (IR, elevated HgA1c). This is basic and should have been explored. BMI isn't even mentioned.
- Nowhere in the study does the investigator say how many of his sample had small fiber neuropathy. He mentions that they were tested for it or some were. Were they selected on the basis of having small fiber neuropathy and therefore would likely respond to metformin? He doesn't say. I registered on PLOS ONE to make that comment.
Interesting (Pappollo is a neurologist at U-TX-Galveston and a spine clinic). He has applied for preliminary patent entitled: Formulations and Methoda for Treatment of Fibromyaliga and Related Myofascial Disorders.
I don't know what to make of the miraculous pain reduction.
I need to be on metformin sooner or later. I guess I will give it a try, if my doc is willing, next month. Will keep you informed.
What Pappollo seems to be hypothesizing is that fibro develops because of insulin resistance. Even when the HgA1c is normal, it is 0.54 units higher per age adjusted controls than it should be. And this is enough to initiate the illness.
- From the introduction, quoted material: (IR = insulin resistance or abnormal HgA1c).
"Prior observations indicate that IR causes dysfunctions in the brain microvasculature leading to focal cerebral hypoperfusion [
11]. Since similar brain perfusion abnormalities are present in patients with FM [
12], we hypothesized that IR may be the missing link in this disorder. In order to search for initial evidence in support of this hypothesis, we conducted a retrospective chart review of patients with FM focusing on potential laboratory abnormalities. In contrast with prior studies, when we applied an age correction to the data available for analysis, specifically to the HbA1c values, unexpected findings came to light. Here, we report that a series of patients with FM belong to a distinct population that can be segregated from a control group by their HbA1c values, a biomarker for impaired glucose metabolism, characterized by insulin resistance [
13,
14].
In order to supplement this finding, we also reviewed the evolution of the pain scores of patients with FM who had had their IR treated pharmacologically. This subgroup of patients reported dramatic improvements of their myofascial pain after treatment with metformin.
This evidence, although preliminary, suggests a pathogenetic relationship between FM and IR, which may lead to a paradigm shift in the management of this disorder."
Wouldn't it just be easier to do survey metformin's effective on pain in fibro patients?
