Comprender la inflamación cerebral en pacientes con fibromialgia

La fibromialgia  (FM) es un trastorno de dolor crónico común y complejo que causa un dolor generalizado y una sensibilidad al tacto que puede ocurrir en puntos sensibles específicos o de activación o en todo el cuerpo.

Los síntomas de la fibromialgia son generalizados y abarcan toda la gama de intensidad. Los síntomas como  fatiga , trastornos del sueño, dificultades cognitivas y rigidez son los más reportados. Los síntomas adicionales incluyen depresión, ansiedad, migrañas,  dolores de cabeza por tensión ,  dolor pélvico , vejiga irritable o  hiperactiva ,  síndrome del intestino irritable  (SII), TMJ y reflujo gastrointestinal. El estrés aumenta la intensidad de los síntomas y puede ser el culpable de un ciclo de dolor que es imposible de manejar.

Aquellos que sufren de fibromialgia generalmente tienen una mayor reacción al estímulo externo. Puede haber una mayor respuesta autonómica a sensaciones cotidianas leves, como sonidos, luces y olores.

Las últimas investigaciones tienden a indicar que esta condición de  hipersensibilidad tiene algo que ver con los cambios en el cerebro .

Cada vez hay más evidencia de que debido a varias condiciones crónicas estresantes, las vías del dolor en el cerebro se ven alteradas. Una persona que vive con fibro a menudo experimentará dolores de cabeza crónicos  , dolores viscerales y otras afecciones dolorosas.

Los acontecimientos estresantes de la vida y los traumas físicos o emocionales provocan el recrudecimiento de las respuestas inflamatorias y estas respuestas se comunican al cerebro. Si estas condiciones estresantes continúan durante bastante tiempo, producen cambios en el cerebro que producen el síndrome de hipersensibilidad.

Recientemente, ha habido un interés mucho mayor en observar las células del cerebro que desempeñan un papel en la inflamación y la hipersensibilidad. Una de esas células conocida por jugar un papel central en las respuestas inflamatorias en el cerebro es la  microglia .

 

Mecanismos de inflamación y afectación neuronal

La inflamación es un mecanismo defensivo. Una vez que el cuerpo se enfrenta a un agente infeccioso, escombros u otro material extraño, se produce inflamación y  se liberan sustancias químicas de los glóbulos blancos del cuerpo  para proteger su cuerpo de sustancias extrañas. El flujo sanguíneo aumenta al área de lesión o infección. Este proceso de protección puede estimular los nervios y causar dolor.  Los macrófagos  son células que liberan al cuerpo de las células gastadas y otros desechos. Junto con las células dendríticas, juegan un papel importante en el envío de una respuesta inflamatoria  .

El centro del cerebro inicia acciones para elevar la temperatura corporal y prevenir el crecimiento microbiano. El cerebro trata de conservar energía forzándonos a descansar, reducir la interacción social y las actividades físicas, por ejemplo. . El cerebro es fundamental para la respuesta al dolor. Pero, ¿cómo ocurre el intercambio de información entre el punto de inflamación y el cerebro? Sucede a través de los mensajeros llamados citocinas, y a través de la entrada de los nervios.

 

Inflamación cerebral y fibromialgia

Ahora sabemos que el cerebro no solo está involucrado en el control de nuestros pensamientos y emociones, sino que también se ocupa automáticamente de manejar las respuestas inflamatorias al trauma, el estrés y otras amenazas. Este mecanismo de defensa que involucra respuestas locales y cambios en el funcionamiento del cerebro ha evolucionado a lo largo de los millones de años de nuestra evolución. Nuestro cuerpo está impecablemente hecho para dar una respuesta adecuada a una amenaza aguda.

Durante el último siglo más o menos, el medio ambiente y las condiciones de vida han cambiado más rápido de lo que nuestro cuerpo puede adaptarse o evolucionar. Las condiciones de trabajo modificadas, un mejor tratamiento de muchos trastornos agudos, cánceres y terapias quirúrgicas, han contribuido al estrés y la inflamación crónica. Nuestro cerebro está continuamente bajo estrés, lo que ha resultado en la sensibilización de diversas estructuras del cerebro. Esta retroalimentación continua al cerebro produce una sensibilización de la microglía que produce respuestas inflamatorias, hipersensibilidad e hiperreacción. Parece que los mecanismos múltiples de defensa de nuestro cerebro y cuerpo no están hechos para operar de esta manera crónica, dando lugar a nuevos tipos de problemas de salud. 

 

Fibromialgia y conexión microglial

La condición estresante crónica hace que las células cerebrales específicas sean hiperreactivas. El resultado es un aumento de los niveles de factores inflamatorios, la sensación de dolor y los cambios de humor, como la depresión o la ansiedad.

Para demostrar esta hipótesis con respecto a la hiperactividad de las células cerebrales microglia en la fibromialgia, se publicó un estudio en la revista Scientific Reports.

Aunque se sospecha desde hace mucho tiempo que la microglia está implicada con la fibromialgia, ha sido difícil estudiar o probar este concepto. Pero con la mejora en la comprensión de la biología celular, se ha hecho posible crear células de tipo microglia inducidas por el ser humano ( iMG ) a partir de otras células derivadas de la circulación sanguínea periférica.

En el estudio publicado, los científicos crearon  iMG  de 14 pacientes con fibromialgia 10 de sujetos con buena salud. Estudiaron las reacciones de las células iMG a la estimulación por ATP extracelular. Los investigadores encontraron que las células de los pacientes con FM demostraron los niveles más altos de factor de necrosis tumoral (TNF), un tipo de mensajero-citoquina inflamatoria. 

Resultado

Este experimento demostró la hiperreactividad de la microglia en individuos que padecen FM. Son estas células hipersensibles las que posiblemente pueden ser responsables de la mayor percepción de dolor e inclinación hacia los trastornos del  estado de ánimo  en la FM.

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