Che cos’è la sindrome del dolore miofasciale e come è associata alla fibromialgia.

La fibromialgia e la sindrome del dolore miofasciale spesso vanno di pari passo. A causa della frequente sovrapposizione e di alcuni sintomi simili, vengono spesso scambiati per la stessa condizione e, di conseguenza, alle persone con entrambi a volte viene diagnosticata e trattata solo per uno.

Questo è un vero problema, per tre ragioni principali:

  1. richiedono un trattamento diverso
  2. I punti trigger di MPS possono essere eliminati
  3. Il dolore da MPS può esacerbare la FMS e ridurre il dolore da MPS può calmare considerevolmente i sintomi della FMS

Alcuni ricercatori usano il nome “dolore miofasciale cronico” (CMP) invece di sindrome del dolore miofasciale a causa dell’evidenza che si tratta di una malattia, non di una sindrome. (Una “sindrome” è un insieme di sintomi senza una causa nota.)

Panoramica

Nella MPS, i muscoli e i tessuti connettivi (che costituiscono la fascia) sviluppano il cosiddetto punto trigger (TrP). Questi non sono  gli stessi punti di gara FMS.

Un punto di innesco è un piccolo nodo duro che a volte puoi sentire sotto la pelle. Il nodo stesso può essere doloroso, specialmente se colpito, ma spesso provoca dolore in un’altra area, che si chiama dolore riferito.

I punti trigger in genere si formano a seguito di un trauma al tessuto. Gli esperti non sanno perché un danno che guarisce normalmente nella maggior parte delle persone causa TrP in altre. Tuttavia, gli studi suggeriscono che la lesione muscolare in alcune persone porta ad anomalie in cui le cellule nervose si collegano alle cellule muscolari. Ciò suggerisce che la MPS è una malattia neuromuscolare.

Associazione

Il motivo per cui le persone con MPS sviluppano frequentemente la FMS non è ancora chiaro, ma un numero crescente di prove mostra che, in alcune persone, il dolore cronico può apportare modifiche al sistema nervoso centrale, con conseguente sensibilizzazione centrale. Se le teorie sono corrette, il trattamento precoce della MPS può aiutare a prevenire la FMS.

Un termine generico emergente per FMS, MPS e altre condizioni che coinvolgono la sensibilizzazione centrale sono le sindromi da sensibilità centrale.

Sintomi

Alcuni sintomi associati alla MPS sono simili ai sintomi associati alla FMS, mentre altri sono collegati solo a uno di essi.

I sintomi che hanno in comune includono:

  • dolore dei tessuti molli che varia da lieve a grave
  • mal di testa e/o emicrania
  • sonno disturbato
  • problemi di equilibrio e/o vertigini
  • tinnito (ronzio nelle orecchie) e dolore all’orecchio
  • problemi di memoria
  • sudorazione inspiegabile
  • peggioramento dei sintomi a causa di stress, cambiamenti/estremi del tempo e attività fisica

I sintomi associati alla MPS ma  non  alla FMS includono:

  • intorpidimento alle estremità
  • schioccare o fare clic sulle giunture
  • gamma limitata di movimento delle articolazioni, in particolare della mascella
  • visione doppia o sfocata
  • nausea inspiegabile

I sintomi associati alla FMS ma  non  alla MPS includono:

  • fatica
  • attacco di panico
  • sentirsi sopraffatti a causa di alti livelli di input sensoriali
  • allergie e sensibilità
  • confusione e disorientamento periodici

Per ulteriori sintomi di fibromialgia, vedere L’elenco dei mostri dei sintomi della fibromialgia.

Diagnosi

Il dolore riferito rende la MPS particolarmente difficile da diagnosticare e trattare. In genere, un medico dice: “Dove fa male?” e poi guarda dove indichi. Per trattare la MPS, tu e il tuo medico dovete esaminare i sintomi e capire dove si trovano i punti trigger.

Il medico può trovare i punti trigger al tatto o in base ai sintomi.

Test come l’elastografia a risonanza magnetica e la biopsia tissutale possono mostrare anomalie nei TrP, ma il loro ruolo nella diagnosi di MPS non è ancora chiaro.

Al contrario, nessun test o scansione rivela anomalie nei tessuti in cui le persone con FMS provano dolore.

Trattamenti

Hai diverse opzioni per il trattamento della MPS:

  • Iniezioni del punto di innesco:  il medico inserisce un ago direttamente in un TrP o in diversi punti intorno ad esso per allentare le bande tese. Il medico può iniettare un farmaco antidolorifico, come corticosteroidi o lidocaina. (Nota: alcuni medici ritengono che i corticosteroidi possano esacerbare i sintomi della fibromialgia.)  Quando non vengono utilizzati farmaci, si parla di dry needling.
  • Agopuntura: l’  agopuntura è un’antica pratica cinese simile al dry needling. Sebbene gli studi sul suo utilizzo nella MPS siano limitati, sono promettenti e molti pazienti e professionisti riportano buoni risultati.
  • Terapia fisica:  un tipo speciale di terapia chiamata spray-and-stretch è comune per il trattamento della MPS. Un fisioterapista ti guida attraverso esercizi di stretching mentre spruzza una sostanza paralizzante sul tuo muscolo. Il terapista può anche utilizzare alcune tecniche di massaggio per sciogliere i muscoli e i TrP. Inoltre, un terapista può lavorare con te su fattori come una cattiva postura che possono contribuire alla MPS.
  • Farmaci: i  farmaci comuni per la MPS includono farmaci antinfiammatori non steroidei (FANS) come Aleve (naprossene) o farmaci a base di ibuprofene come Advil e Motrin e antidepressivi triciclici come amitriptilina, doxepina e nortriptilina.

Trattamenti MPS vs. Trattamenti FMS

Anche in questo caso ci sono alcune sovrapposizioni ma anche importanti differenze. I trattamenti utilizzati sia per MPS che per FMS includono:

  • agopuntura
  • terapia fisica (anche se in forme diverse)
  • antidepressivi triciclici (sebbene gli antidepressivi SSRI/SNRI stiano diventando più comuni per la FMS)

Gli studi mostrano che le iniezioni dei punti trigger non sono efficaci nell’alleviare i punti sensibili della fibromialgia e che i FANS non sono efficaci nel trattamento del dolore da FMS.

Per ulteriori informazioni sui trattamenti della fibromialgia, vedere Trattamento della fibromialgia: un approccio multidisciplinare.

far fronte

Con differenze significative nei loro sintomi, diagnosi e trattamento, è chiaro che la fibromialgia e la sindrome del dolore miofasciale non sono la stessa condizione. Tuttavia, può essere estremamente difficile determinare quale condizione sta causando quale dolore quando una persona li ha entrambi.

Lavorando sia da solo che con il tuo medico e/o fisioterapista, potresti essere in grado di capire dove hai punti trigger e come trattarli al meglio senza esacerbare la tua fibromialgia. È probabile che alleviare il dolore miofasciale calmi i sintomi della fibromialgia, quindi potresti vedere un doppio beneficio.

13 thoughts on “Che cos’è la sindrome del dolore miofasciale e come è associata alla fibromialgia.

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