Ambroxol for the treatment of fibromyalgia: science or fiction?
Authors Kern KU, Schwickert M
Received 8 April 2017
Accepted for publication 19 July 2017
Published 16 August 2017 Volume 2017:10 Pages 1905—1929
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Minal Joshi
Peer reviewer comments 2
Editor who approved publication: Dr Michael E Schatman
Kai-Uwe Kern, Myriam Schwickert
Institute of Pain Medicine/Pain Practice, Wiesbaden, Germany
Abstract: Fibromyalgia appears to present in subgroups with regard to biological pain induction, with primarily inflammatory, neuropathic/neurodegenerative, sympathetic, oxidative, nitrosative, or muscular factors and/or central sensitization. Recent research has also discussed glial activation or interrupted dopaminergic neurotransmission, as well as increased skin mast cells and mitochondrial dysfunction. Therapy is difficult, and the treatment options used so far mostly just have the potential to address only one of these aspects. As ambroxol addresses all of them in a single substance and furthermore also reduces visceral hypersensitivity, in fibromyalgia existing as irritable bowel syndrome or chronic bladder pain, it should be systematically investigated for this purpose. Encouraged by first clinical observations of two working groups using topical or oral ambroxol for fibromyalgia treatments, the present paper outlines the scientific argument for this approach by looking at each of the aforementioned aspects of this complex disease and summarizes putative modes of action of ambroxol. Nevertheless, at this point the evidence basis for ambroxol is not strong enough for clinical recommendation.
Keywords: Nav 1.8, Nav 1.7, bromhexine, hyperalgesia, sympathetically maintained pain, central sensitization, interleukins, neuropathic pain, sodium channels
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