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Creatine no help for Fibromyalgia

Wednesday 4 September 2013


From MedPage Today:


TabletsCreatine No Help for Fibromyalgia

Published: Aug 30, 2013 | Updated: Sep 1, 2013

By Nancy Walsh, Staff Writer, MedPage Today

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Creatine supplementation improved several measures of muscle function in patients with fibromyalgia in a small randomized trial, but most symptoms didn't improve.

Among a group of women with fibromyalgia given 4 months of daily creatine supplementation, there was an 80% increase in the intramuscular content of phosphorylcreatine compared with patients receiving placebo (+80.3% versus -2.7%, P=0.04), according to Bruno Gualano, PhD, and colleagues from the University of Sao Paulo in Brazil.

In addition, muscle strength showed improvements on both the leg press and chest press with creatine, at +9.8% and +1.2%, respectively, compared with changes of -0.5% (P=0.02) and -7.2% (P=0.002) for placebo, the researchers reported in the September Arthritis Care & Research.

However, almost no benefits were seen for pain, quality of life, sleep, or cognitive function.

"I would ask why this study was even done," said Dennis Ang, MD, of Wake Forest University in Winston-Salem, N.C., in an interview.

The premise of the study was based on research from the mid-90s, Ang said, and since that time, much more has been learned about fibromyalgia.

"Current thinking is that the potential causes of fibromyalgia reside mostly in the brain, and not much in the periphery or the muscle itself. This study assumed that the problem is mostly in the muscle," he said.

"I am therefore not surprised that there were no significant clinical findings except in the muscles, because creatine wouldn't have any effect on the major symptoms of fibromyalgia," Ang told MedPage Today.

Fibromyalgia is an incompletely understood condition in which patients experience pain, muscle weakness, psychological and cognitive problems, and sleep abnormalities.

"There is evidence suggesting that abnormal muscle bioenergetics may underlie the physiopathology of fibromyalgia," stated Gualano and colleagues.

Creatine is required in muscle energy production as it is involved in the production of ATP following enzymatic effects on phosphorylcreatine.

In one study using 31P magnetic resonance spectroscopy, patients with fibromyalgia were found to have decreased levels of ATP and phosphorylcreatine, which some researchers have speculated may contribute to the myriad symptoms of the disease.

A previous uncontrolled, short-term study found benefits for creatine use in fibromyalgia on various disease domains, including disease severity, pain, and quality of life, but definitive conclusions couldn't be drawn because of the study design limitations.

So Gualano's group conducted a double-blind trial in which 32 women were randomized to receive creatine supplements in dosages of 20 g per day for the first 5 days and then in daily doses of 5 g, or placebo.

Patients' mean age was 49, and disease duration was 4 years.

They were taking a variety of medications, as is common among patients with fibromyalgia, including fluoxetine, cyclobenzaprine, and amitriptyline.

Four patients withdrew during the course of the trial, three in the placebo group and one in the creatine group.

In addition to the increased strength on press tests, patients receiving creatine also had increased isometric strength (+6.4% versus -3.2%, P=0.007), but no changes were seen on measures of aerobic capacity such as maximal oxygen consumption and ventilatory anaerobic threshold.

The only clinical improvements in symptoms were an increase of 9.1% on the pre-sleep domain of a sleep quality questionnaire (P=0.006), and an improvement of 29.3% (P=0.03) on the mental health domain of the Short Form-36 quality of life questionnaire.

And the sole benefit seen for cognitive performance was a trend toward improvement on the delayed recall test (+11.8%, P=0.07).

These findings of few effects on the extra-muscular fibromyalgia symptoms were in contrast with the results of the earlier uncontrolled study.

The benefits reported in that study may have represented a placebo effect, or the current study may have been underpowered to detect these effects, according to Gualano and colleagues.

Several mechanisms have been postulated to explain muscle abnormalities in fibromyalgia, including poor tissue oxygenation, ischemia, calcium and potassium disruptions, and a resulting failure of ATP synthesis.

"The current findings allow the suggestion that creatine supplementation could block this vicious circle by inducing an increase in intramuscular phosphorylcreatine, possibly re-establishing ATP homeostasis," the researchers wrote.

Ang disagreed that creatine may have a clinical role in fibromyalgia.

"As a clinician, it really would not help me in any way or change my management of patients with fibromyalgia," he said.

Limitations of the study, according to the authors, were the use of multiple other medications by participants and the small population included.

Also, more patients in the creatine group were taking antidepressants, which could have influenced the mental health effects.

The study was supported by CNPq and FAPESP.

The authors reported no disclosures.

Primary source: Arthritis Care & Research

Source reference: Alves C, et al "Creatine supplementation in fibromyalgia: A randomized, double-blind, placebo-controlled trial" Arthritis Care Res 2013; 65: 1449-1459.


The above originally appeared here.


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