Uiteindelijk Fibromyalgie is beschouwd als een levenslang centraal zenuwstelsel stoornis

Fibromyalgie is de tweede meest voorkomende reumatische aandoening achter osteoartritis en, hoewel nog steeds op grote schaal verkeerd begrepen, wordt nu beschouwd als een levenslange van het centrale zenuwstelsel, die verantwoordelijk is voor versterkte pijn die door het lichaam schiet in degenen die lijden aan het. Daniel Clauw, MD, professor in de anesthesiologie, University of Michigan, analyseerde de neurologische basis voor fibromyalgie in een plenaire zitting adres vandaag op de American Pain Society Annual Scientific Meeting.

 

“Fibromyalgie kan worden gezien zowel als een discreet ziekte en ook als een laatste gemeenschappelijke route van pijn centralisatie en chronisch worden. De meeste mensen met deze aandoening hebben levenslange geschiedenis van chronische pijn in heel hun lichaam “, zegt Clauw. “De aandoening kan moeilijk te diagnosticeren als men niet bekend is met klassieke symptomen, want er is geen enkele oorzaak en geen uiterlijke tekenen.”

Clauw uitgelegd dat fibromyalgiapijn komt meer van de hersenen en het ruggenmerg dan uit gebieden van het lichaam waarin iemand perifere pijn kan ondervinden. De aandoening wordt verondersteld te worden geassocieerd met stoornissen in de manier waarop de hersenen verwerken pijn en andere zintuiglijke informatie. Hij zei dat artsen moeten fibromyalgie bij patiënten met multifocale (meestal musculoskeletale) pijn die niet volledig worden verklaard door letsel of ontsteking vermoedt.

“Omdat pijnbanen door het hele lichaam worden versterkt in fibromyalgie patiënten kan pijn overal voorkomen, zo chronische hoofdpijn, viscerale pijn en sensorische hyperreactiviteit komen vaak voor bij mensen met deze pijnlijke aandoening,” zegt Clauw.

“Dit betekent niet dat perifere nociceptieve ingang draagt ​​niet bij aan de pijn ervaren door fibromyalgie patiënten, maar ze voelen zich meer pijn dan normaal zou worden verwacht van de mate van perifere input. Personen met fibromyalgie en andere pijntoestanden gekenmerkt door sensibilisatie zal pijn van wat mensen zonder de aandoening zou omschrijven als aanraking,”Clauw toegevoegd.

Vanwege het centrale zenuwstelsel ontstaan ​​van fibromyalgie pijn, Clauw genoemde behandelingen met opioïden en andere narcotische analgetica gewoonlijk niet effectief omdat ze de activiteit van neurotransmitters in de hersenen niet verminderen. “Deze drugs zijn nooit aangetoond dat ze effectief bij fibromyalgie patiënten te zijn, en er zijn aanwijzingen dat opioïden zelfs fibromyalgie en andere gecentraliseerde pijn staten zou kunnen verergeren,” zei hij.

Clauw adviseert clinici farmacologische behandelingen, zoals gabapentinoids, trycyclics en serotonoin heropnameremmers integreren met niet-farmacologische benaderingen, zoals cognitieve gedragstherapie, lichaamsbeweging en stress te verminderen.

“Soms is de omvang van de behandeling respons voor eenvoudige en goedkope niet-medicamenteuze therapieën groter is dan die voor de farmaceutische industrie,” zei Clauw. “Het grootste voordeel is verbeterde functie, die de belangrijkste behandeling doel voor elke chronische pijn aandoening moet zijn. De meerderheid van de patiënten met fibromyalgie kan verbetering in hun symptomen en een normaal leven leiden met de juiste medicijnen en uitgebreid gebruik van niet-medicamenteuze behandelingen.”

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