Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

The Hepatitis-Fibromyalgia Connection

Fibromyalgia and chronic hepatitis C infection share many clinical features.

Fibromyalgia and chronic hepatitis C infection share many clinical features including prominent somatic complaints such as musculoskeletal pain and fatigue. In fact, some medical experts believe that the symptoms and presenting patterns in common between hepatitis C and fibromyalgia are not coincidental. There is the possibility that hepatitis C may be a trigger of fibromyalgia.

There is a growing body of evidence supporting a link between cytokines and somatic complaints. There have been reports of alterations of cytokines in fibromyalgia, including increased serum levels of interleukin (IL)-2, IL-2 receptor, IL-8, IL-1 receptor antagonist, and increased IL-1 and IL-6 produced in patients with fibromyalgia for longer than 2 years, to name but a few.

Alterations in the cytokines of fibromyalgia and chronic hepatitis C infection can produce hyperalgesia and other neurologically-mediated complaints, as the cytokine receptors can be found on brain cells and opiate receptors on blood cells.

Many individuals with other liver diseases do not suffer the pain seen in hepatitis C. And there is a high prevalence of fibromyalgia in hepatitis C patients; this is important for clinicians to appreciate, as the recognition of fibromyalgia in patient with hepatitis C will prevent assumptions of pain being due to liver disease—and perhaps allow for a more focused and correct treatment approach.

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In recent years there has been a significant effort to educate the public on viral hepatitis, such as hepatitis B and C, to encourage testing and educate regarding prevention and treatment. It is always important to consider these infections when patients experience fatigue and/or pain for seemingly no reason.

Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants.

Ask your doctor about hepatitis B and C testing should you feel there are unexplained symptoms you might be experiencing. You risk a needle stick, but you gain peace of mind.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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