Em última análise, fibromialgia tem sido considerado como um transtorno do sistema nervoso central ao longo

A fibromialgia é a segunda doença reumática mais comum por trás osteoartrite e, embora ainda amplamente mal compreendida, agora é considerado um distúrbio do sistema nervoso central ao longo da vida, que é responsável pela dor amplificada que atira através do corpo em pessoas que sofrem com isso. Daniel Clauw, MD, professor de anestesiologia da Universidade de Michigan, analisou a base neurológica para a fibromialgia em um endereço sessão plenária hoje no Encontro Científico Anual da Sociedade Americana de Dor.

 

“A fibromialgia pode ser considerada tanto como uma doença discreta e também como uma via final comum de centralização dor e cronificação. A maioria das pessoas com esta condição têm histórias ao longo da vida de dor crônica em todo o corpo “, disse Clauw. “A condição pode ser difícil de diagnosticar se a pessoa não está familiarizado com sintomas clássicos, porque não existe uma única causa e nenhum sinal.”

Clauw explicou que a dor fibromialgia vem mais do cérebro e da medula espinhal do que de áreas do corpo em que alguém pode sentir dor periférica. A condição é que se acredita estar associado com distúrbios na forma como o cérebro processa dor e outras informações sensoriais. Ele disse que os médicos devem suspeitar de fibromialgia em pacientes com multifocal (principalmente músculo-esquelética) dor que não é totalmente explicada por lesão ou inflamação.

“Porque vias de dor em todo o corpo são amplificados em pacientes com fibromialgia, a dor pode ocorrer em qualquer lugar, por isso, dores de cabeça crônicas, dor visceral e sensorial hiper-responsividade são comuns em pessoas com esta condição dolorosa”, disse Clauw.

“Isto não implica que a entrada nociceptiva periférica não contribui para a dor sentida por pacientes com fibromialgia, mas eles se sentem mais dor do que normalmente seria esperado a partir do grau de entrada periférica. Pessoas com fibromialgia e outros estados de dor caracterizada pela sensibilização vai sentir dor do que aqueles sem a condição descreveria como toque “, acrescentou Clauw.

Devido às origens do sistema nervoso central de dor fibromialgia, Clauw referidos tratamentos com opióides e outros analgésicos narcóticos não são geralmente eficazes porque eles não reduzem a actividade de neurotransmissores no cérebro. “Estas drogas nunca foi mostrado para ser eficaz em pacientes com fibromialgia, e há evidências de que os opióides podem até piorar a fibromialgia e outros estados de dor centralizados”, disse ele.

Clauw aconselha clínicos para integrar tratamentos farmacológicos, tais como gabapentinoids, trycyclics e inibidores selectivos da recaptação serotonoin, com abordagens não farmacológicas, como terapia comportamental cognitiva, exercício e a redução do stress.

“Por vezes, a magnitude da resposta ao tratamento para terapias não-droga simples e baratos que excede para uso farmacêutico,” disse Clauw. “O maior benefício é a melhoria da função, que deve ser o principal objetivo do tratamento para qualquer condição de dor crônica. A maioria dos pacientes com fibromialgia pode ver melhora em seus sintomas e levar uma vida normal com a medicação certa e amplo uso de terapias não-droga “.

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