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VBCR - August 2015, Volume 4, No 4 - Fibromyalgia

Jarred Younger, PhD, is an Associate Professor in the Departments of Psychology, Anesthesiology, and Rheumatology, and the Director of the Neuroinflammation, Pain and Fatigue Lab at the University of Alabama at Birmingham (UAB).

Value-Based Care in Rheumatology asked Younger to discuss the economic implications of finding a treatment for fibromyalgia, the importance of biomarkers, and how microglial modulation could one day reverse the effects of aging.

How can fibromyalgia research help reduce the cost of care and streamline the prescription diagnosis process?

Right now, people with fibromyalgia see upwards of 14 different physicians. They get tried on every single medication you can think of, and they’re all failing. There’s a lot of expense with that. There’s also a lot of expense with being out of work for 20 years, as patients are waiting for the right medication. So, of course, if one of these new microglial modulators hits the target, and if we can identify that and it can be a first-line treatment, then we’re avoiding the cost of disability. We’re also avoiding the cost of trying a bunch of drugs that are expensive and don’t work. If we get these microglial modulators to work as well as we think and get them into mainstream practice, then it will ultimately reduce costs. There’s nothing out there like it right now.

What are some of the new drugs in development for fibromyalgia?

The first drug I should mention is naltrexone. As far as cheap goes, this drug is dirt cheap. And that’s because it’s generic. So that’s something any rheumatologist can prescribe, and it costs people about $35 to $40 out of pocket, with no insurance at all, because it’s off patent. I don’t know if that’s of interest to people, but that certainly is as cheap as it gets. There’s a company called Immune Therapeutics, which has been attempting to get a commercial, FDA [US Food and Drug Administration]-approved, branded low-dose naltrexone in the 4.5-mg capsule and also in 1-mg capsule so people can titrate. Their chief scientific officer told me that, if they’re successful, they’re going to charge the same as generic, so it would still be $35/month—about $1/day.

Why is finding a biomarker for fibromyalgia so important?


There are so many reasons why that’s a critical step. I think a lot of fibromyalgia cases are misdiagnosed, and a lot of cases are called fibromyalgia when they’re not really fibromyalgia. So the objective blood test would tell us who actually needs these types of drugs. Right now, diagnosis is just based on symptoms. You could have MS [multiple sclerosis]; you could have Lyme disease: so many things look like fibromyalgia. So it would help with that.

What about the psychology of the patients?


The biggest thing for patients is they don’t feel like they’re being taken seriously by the medical community, and it’s because it’s all self-report. They come in to the physician saying, “I feel horrible, I feel pain,” and frankly a lot of physicians don’t believe them, especially when they give them an opioid and it doesn’t work. Physicians think, “You can’t be in pain or else this would help.” So it would help the patients feel better, and it would help them have their disease recognized. Physicians and clinicians would know there’s something definitely wrong. The other thing is, whenever you have an objective biomarker, it tells you what’s dysregulated, and that tells you what to target with your treatment. So, if we came up with a blood test, then all the people who develop drugs would know what to go after. Having a biomarker would help in so many different ways.

Why have you decided to focus on fibromyalgia?


I don’t have it myself. I don’t have any family members who have it, but I do have family members with pain. One of the reasons I got into pain is because I’ve seen what opioids can do to people, and I realized that we need better treatments. When I did my first post-doc at Arizona State University in Tempe, they were studying fibromyalgia, osteoarthritis [OA], and rheumatoid arthritis [RA]. We know quite a lot about RA and OA, and they’re taken seriously, but fibromyalgia was just so mysterious. And so it was an interesting scientific problem for me, because we knew nothing about it. I talked to some of the patients about it. Some of them owned businesses. Some of them were athletes. And then something happened—a car wreck or they got sick—and they’ve never been the same since, and they said, “We just want to get back to our normal life.” I was moved by their stories, so I decided that fibromyalgia was the thing I was going to figure out. I believe that if we fix fibromyalgia, it’s going to have implications well beyond fibromyalgia.

What are some of these implications?

I think the evidence is strongly supporting the role of microglia in fibromyalgia and a lot of other neurologic conditions and disorders. I think this is going to be the next huge advance in treatment when we figure out how to manipulate these microglia cells. And I think that when we have those treatments, we’re going to have an effective treatment for not just fibromyalgia, but chronic fatigue syndrome, irritable bowel syndrome, Gulf War illness, and a lot of other chronic multisymptom illnesses—not just those but major depressive disorder. We’ll have a treatment for chronic traumatic brain injury. We’ll have an adjunctive treatment for rheumatoid arthritis with inflammation as infiltrated in the central nervous system and other rheumatologic disorders. And not just those pathological conditions, but I think that a lot of the phenomena that we associate with normal aging—like increased fatigability, increased pain sensitivity, and decreased cognitive function—I believe a lot of those things are not actually inevitable; they are driven by inflammatory processes. So, if we could employ these treatments, we could actually prevent or reverse several major adverse aspects of aging. The implications of this treatment approach are huge, and this field is wide open for exploration. So I’m really excited to be working in this area.

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Last modified: August 26, 2015
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