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The role of involvement of IL-6 and other cytokines in different aspects of chronic myalgia needs further investigation.
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Chronic myalgia is associated with higher muscle levels of certain algesic biomarkers.
Thus these substances can be regarded as potential biomarkers for chronic myalgia.
This give further support that muscle inflammation may drive chronic myalgia, but that patients with TMD myalgia have a normal anti-inflammatory response to exercise.
Several studies have shown that 5-HT concentrations are significantly elevated in painful muscles of patients with chronic myalgia [3 6].
5-HT concentrations have been found to be significantly elevated in painful muscles of patients with chronic myalgia [10 12].
Thus, repeated intramuscular injections with granisetron may offer a novel and additional treatment approach for patients with chronic myalgia.
Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model.
Several studies have shown that patients with chronic myalgia have higher interstitial levels of 5-HT and glutamate in the masseter and trapezius muscles compared to healthy controls, and that muscle levels correlated to pain levels [15 20].
In addition, interstitial levels of lactate and pyruvate increased in painful trapezius muscle, which may also indicate a role for metabolic markers in chronic myalgia [17, 18, 23, 24].
Therefore, the larger amount of putatively nociceptive nerve fibers in the connective tissue of the masseter muscle and the difference in innervation might partly explain the more frequent presence of chronic myalgia in the masseter muscle.
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