A recent article in the journal Current Pain and Headache Reports discusses the use of melatonin as a treatment for fibromyalgia. First the authors reported on four studies that measured melatonin levels at various times of day and night using both FM patients and healthy controls. The results of those studies suggested that FM is not associated with a major change in nocturnal melatonin synthesis or release.
Conversely, they reported on two small, open studies testing the use of melatonin as a treatment for FM. In both studies all FM patients participating reported significant improvement. One study used 3mg of melatonin and the other used 6mg. Following the second study, researchers found that 10mg of melatonin nightly brought more relief. Although the sizes of these studies were very small, the authors felt they were worth noting because all of the patients reported improvement.
The varied results of these different studies raise the question: If fibromyalgia patients do not have abnormally low nighttime levels of melatonin, why did the use of melatonin seem to improve FM symptoms? The article offered five possible explanations:
1. Sleep disturbances and the disruption of circadian rhythms frequently occur in fibromyalgia. Melatonin has often been shown to synchronize circadian rhythms and improve the quality of sleep.
2. Excessive free-radical damage has been observed in FM patients. Melatonin and its metabolites have been shown to be potent free-radical scavengers and indirect antioxidants.
3. It has been reported that nitric oxide synthesis is increased in FM patients. Melatonin is a potent inhibitor of the rate-limiting enzyme in nitric oxide production.
4. Depression is sometimes a symptom or overlapping condition of fibromyalgia. Melatonin has been proposed as an antidepressant. (One component of melatonin has been synthesized by the pharmaceutical industry and is being promoted as an antidepressant.)
5. Antiepileptic drugs (i.e., Lyrica) have shown some effectiveness in treating FM. Melatonin has also been shown to function as an antiepileptic.
The authors concluded that the next step should be “a multi-center, crossover trial using a larger number of FM patients diagnosed by rigorous criteria and careful objective evaluation of the symptoms.” They felt that such a study would be justified when weighing the severity of symptoms and relative ineffectiveness of current FM treatments against the high safety profile and low cost of melatonin.
Finally, the authors urge the clinical community to consider melatonin as an option, either alone or in conjunction with other treatments, when treating fibromyalgia. They recommend that melatonin be taken orally or sublingually 30 minutes before bedtime.
Note: Before taking any supplement or over-the-counter medication, always check with your doctor to avoid possibly dangerous interactions with medications you are taking.
Source: Reiter, Russel J. Current Pain and Headache Reports. 2007. 11:339-342.
Published On: October 08, 2007