Muchos en la comunidad médica han aceptado durante muchos años que la fibromialgia es un síndrome de dolor crónico, ni siquiera una enfermedad. Y ciertamente no matar a nadie. Sin embargo, ha habido informes esporádicos en la literatura de aumento de la mortalidad debido a enfermedad cardiovascular y suicidio. Un estudio publicado el año pasado en “Arthritis and Rheumatism” encontró tendencias inquietantes en una cohorte de pacientes con fibromialgia que pueden cambiar el enfoque de la comunidad de la atención de la salud a la fibromialgia.
Los principales hallazgos de este estudio de 1,269 pacientes mujeres Dansih fueron los mayores riesgos de muerte por suicidio, enfermedad hepática y enfermedad cerebrovascular. Es inquietante que el riesgo de suicidio entre los pacientes con fibromialgia sea diez veces mayor que el de la población general. Sin embargo, ninguno de los pacientes con fibromialgia que se suicidaron tenía un historial médico de depresión u otra enfermedad psiquiátrica en el momento del diagnóstico. Esto es de interés porque los estudios previos han encontrado mayores tasas de depresión, ansiedad, dolor, fatiga y otros trastornos psiquiátricos.
Existe una tendencia a la falta de notificación cuando se trata de suicidio, sin importar el país. La incidencia del suicidio se ve afectada por la integración social y la imitación. En Dinamarca, hay una relativa falta del estigma que a menudo rodea al suicidio; y esto, junto con el hecho de que se requieren autopsias cuando se sospecha un suicidio, parece asegurar estimaciones bastante precisas de la tasa de suicidios.
Este mayor riesgo de suicidio puede tener alguna relación con la mayor tasa de muerte accidental en pacientes con fibromialgia: es muy posible que una muerte aparentemente “accidental” sea en realidad un suicidio (por ejemplo, una caída o un solo vehículo). accidente). Un diagnóstico de dolor crónico se asocia con una mayor mortalidad debido a una variedad de causas externas.
Una mayor tasa de mortalidad debido a enfermedad hepática en la fibromialgia puede estar relacionada con el consumo de alcohol. Según la Organización Mundial de la Salud, Dinamarca tiene una alta tasa de consumo de alcohol. Además, el dolor parecido a la fibromialgia a menudo es informado por pacientes con hepatitis C.
El aumento de la tasa de enfermedad cerebrovascular en pacientes con fibromialgia puede deberse al hecho de que muchos pacientes con fibromialgia tienen sobrepeso, si no son obesos. De hecho, el 19% de los pacientes con fibromialgia eran obesos y el 54% eran fumadores actuales, más de la mitad de estos fumadores empedernidos. Los sujetos sanos demostraron una mejor respuesta cardiovascular al estrés físico y emocional. Por supuesto, la inactividad física debido al dolor puede contribuir a la aterosclerosis.
Physicians need to seek risk factors for suicide, liver disease and cerebrovascular disease whenever a fibromyalgia patient presents for an evaluation. It is a little more work, but more than chronic pain will likely need to be addressed by patient and provider.
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