Fibromyalgia: Milnacipran Outcomes, Potential Biomarker for Treatment

A new study analyzed multiple areas of fibromyalgia including pain, brain characteristics, and medication efficacy, which resulted in some very telling conclusions.

The authors behind the new research published in the latest issue of The Journal of Pain had several predictions. For one, they thought that patients with fibromyalgia would have increased ventricular lactate levels at baseline — like patients with chronic fatigue syndrome do. Next they hypothesized that treatment with milnacipran for eight weeks would lower those levels when compared with a placebo. Finally, the believed that the medication would improve scores in the Attention Network Test – which assesses the alerting, orienting, and executive control networks.

But which of these hypotheses, if any, were proven correct?

Proton magnetic resonance spectroscopic imaging was used to determine ventricular (cerebrospinal fluid) lactate levels. Patients with fibromyalgia proved to have higher levels at baseline when compared to healthy controls. This suggests that this component is not only a determinant in patients with chronic fatigue syndrome, but in those with fibromyalgia as well. In addition, lactate measurements may be predict therapeutic responses.

Milnacipran, branded under the name Savella, was first approved by the US Food and Drug Administration (FDA) to manage fibromyalgia in 2009. Although the serotonin/norepinephrine reuptake inhibitor does not treat mental illnesses, it works like antidepressants. The team looked at patients who had taken milnacipran versus a placebo.

“A significantly larger proportion of patients treated with milnacipran showed decreases in both ventricular lactate and pain than those treated with placebo,” the authors wrote. While milnacipran proved to lower ventricular lactate levels, they remained higher than the healthy controls. They think that these decreases occurred because the medication reduces central inflammation.

Furthermore, the medication did not appear to influence cognitive processing. However, the findings suggest that milnacipran targets glial activation and neuroinflammation to interfere with brain response, the researchers explained.

Fibromyalgia has long associated with altered brain processing and mental health, but pinpointing the direct relationship has been challenging. But what the team did here adds to the growing evidence that will one day result in answering these crucial questions.