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178,179 Multiple systematic reviews of clinical trials and case reports have found that low-dose naltrexone probably reduces pain and improves quality of life in people with fibromyalgia, but can also cause adverse side effects such as insomnia, vivid dreams, and digestive upset

113 For example, one meta-analysis that included four randomized controlled trials involving 612 fibromyalgia patients found PNE improved fibromyalgia impact as well as pain intensity, catastrophizing, depression, and anxiety

However, other studies have shown that increased levels of TMAO are associated with increased risk of CVD

The first two raise both serotonin and norepinephrine, and it is the impact on norepinephrine that is activating