Cos’è la sindrome del dolore miofasciale e come si associa alla fibromialgia?

La sindrome fibromialgica e il 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 quindi le persone con entrambi vengono talvolta diagnosticati e trattati solo per uno.

Questo è un vero problema, per tre ragioni principali:

  1. richiedono un trattamento diverso
  2. I punti trigger MPS possono essere eliminati
  3. Il dolore da MPS può esacerbare la sindrome fibromialgica e la diminuzione del dolore da MPS può alleviare significativamente i sintomi della sindrome da fibromialgia

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

Presentazione

Nella MPS, i muscoli e i tessuti connettivi (che costituiscono la fascia) sviluppano quello che viene chiamato un punto trigger (TrP). Che   non   sono    , non    lo stesso di punti FMS di gara.

Un punto trigger è un piccolo nodo duro che a volte puoi sentire sotto la pelle. Il nodo stesso può essere doloroso, soprattutto quando prude, ma spesso causa dolore in un’altra area, chiamata dolore riferito.

I punti trigger di solito si formano a seguito di un trauma tissutale. Gli esperti non sanno perché il danno che normalmente guarisce nella maggior parte delle persone causa punti trigger negli altri. Tuttavia, gli studi suggeriscono che il danno muscolare in alcune persone provoca anomalie in cui le cellule nervose si connettono alle cellule muscolari. Ciò suggerisce che la MPS è una malattia neuromuscolare.

Associazione

Il motivo per cui le persone con MPS sviluppano spesso la FMS non è ancora chiaro, ma un numero crescente di prove mostra che, in alcune persone, il dolore cronico può disturbare il sistema nervoso centrale, portando alla 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 è la sindrome della sensibilità centrale.

Sintomi

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

I sintomi comuni includono:

  • dolore ai tessuti molli che va da lieve a grave
  • mal di testa e / o emicrania
  • sonno disturbato
  • problemi di equilibrio e / o vertigini
  • tinnito (ronzio nelle orecchie) e mal d’orecchi
  • problemi di memoria
  • sudorazione inspiegabile
  • peggioramento dei sintomi dovuto a stress, cambiamenti climatici / estremi e attività fisica

I sintomi associati a MPS ma    non a    FMS includono:

  • intorpidimento degli arti
  • schioccare o fare clic sulle articolazioni
  • gamma limitata di movimento nelle articolazioni, in particolare la mascella
  • visione offuscata o doppia
  • nausea inspiegabile

I sintomi associati a FMS ma    non a    MPS includono:

  • fatica
  • attacchi di panico
  • sentirsi sopraffatti a causa di alti livelli di input sensoriale
  • allergie e sensibilità
  • confusione periodica e disorientamento

Per ulteriori sintomi della fibromialgia, vedere l’elenco mostruoso dei sintomi della fibromialgia.

Diagnosi

Il dolore riferito rende la MPS particolarmente difficile da diagnosticare e trattare. Di solito un medico dice: “Dove fa male?” Poi guarda dove sta indicando. Per trattare la MPS, tu e il tuo medico dovete esaminare i sintomi e determinare dove si trovano i trigger.

Il medico può trovare punti trigger per il tatto o in base ai sintomi.

Test come l’elastografia MRI e la biopsia tissutale possono mostrare anomalie dei punti trigger, ma i loro ruoli nella diagnosi della MPS non sono ancora chiari.

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

Offerte

Sono disponibili diverse opzioni per il trattamento dell’MPS:

  • Iniezioni del punto trigger:    il medico inserisce un ago direttamente in un TrP o in vari punti attorno ad esso per allentare le fasce strette. Il medico può iniettare un analgesico, come corticosteroidi o lidocaina. (Nota: alcuni medici ritengono che i corticosteroidi possano esacerbare i sintomi della fibromialgia.)    Quando non viene utilizzato alcun medicinale, si parla di dry needling.
  • Agopuntura: L’    agopuntura è un’antica pratica cinese simile al dry needling. Sebbene gli studi sul suo utilizzo nell’MPS siano limitati, sono promettenti e molti pazienti e professionisti riportano buoni risultati.
  • Terapia fisica:    un tipo speciale di terapia chiamata irrorazione e stretching è comune per il trattamento della MPS. Un fisioterapista ti guida attraverso esercizi di stretching mentre spruzza una sostanza paralizzante sui tuoi muscoli. Il terapista può anche utilizzare alcune tecniche di massaggio per rilassare i muscoli e i punti trigger. 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 sovrapposizioni, ma ci sono anche differenze importanti. I trattamenti utilizzati per MPS e FMS includono:

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

Gli studi dimostrano che le iniezioni di trigger point non sono efficaci nell’alleviare i punti dolenti della fibromialgia e i FANS non sono efficaci nel trattamento del dolore da FMS.

Per ulteriori informazioni sui trattamenti per la fibromialgia, vedere Fibromyalgia Treatment, A Multidisciplinary Approach.

Viso

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

Lavorando da solo e con il tuo medico e / o fisioterapista, puoi determinare dove hai punti trigger e come trattarli al meglio senza peggiorare la tua fibromialgia. È probabile che alleviare il dolore miofasciale allevi i sintomi della fibromialgia, quindi potresti vedere un doppio beneficio.

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