Fibromyalgie ist die zweithäufigste rheumatische Erkrankung nach Arthrose und wird, obwohl immer noch weitgehend missverstanden, als lebenslange Erkrankung des zentralen Nervensystems angesehen, die für die vermehrten Schmerzen verantwortlich ist, die zu Hause den Körper durchziehen. diejenigen, die darunter leiden

Daniel Clauw, MD, Professor für Anästhesiologie an der University of Michigan, analysierte heute in einer Plenarsitzung auf der jährlichen wissenschaftlichen Tagung der American Pain Society die neurologischen Grundlagen der Fibromyalgie.

“Fibromyalgie kann sowohl als diskrete Erkrankung als auch als gemeinsamer Endweg der Zentralisierung und Chronologie von Schmerzen betrachtet werden. Die meisten Menschen mit dieser Erkrankung haben eine lange Geschichte chronischer Schmerzen in ihrem Körper “, sagte Clauw. “Der Zustand kann schwierig zu diagnostizieren sein, wenn man die klassischen Symptome nicht kennt, weil es keine einzige Ursache und kein äußeres Zeichen gibt”.

Clauw erklärte, dass der Schmerz der Fibromyalgie mehr vom Gehirn und vom Rückenmark ausgeht als von Körperbereichen, in denen eine Person an peripheren Schmerzen leidet. Es wird angenommen, dass der Zustand mit Störungen in der Art und Weise verbunden ist, wie das Gehirn Schmerz und andere sensorische Informationen verarbeitet. Er sagte, Ärzte sollten Fibromyalgie bei Patienten mit multifokalen (hauptsächlich muskuloskelettalen) Schmerzen vermuten, die nicht vollständig durch Verletzungen oder Entzündungen erklärt werden.


“Da bei Fibromyalgie-Patienten die Schmerzbahnen im gesamten Körper verstärkt werden, können Schmerzen überall auftreten, so dass chronische Kopfschmerzen, viszerale Schmerzen und sensorische Überempfindlichkeit häufig sind. bei Menschen, die an diesem schmerzhaften Zustand leiden “, sagte Clauw.

“Dies bedeutet nicht, dass die periphere nozizeptive Entbindung nicht zu den Schmerzen bei Patienten mit Fibromyalgie beiträgt, sondern dass sie mehr Schmerzen verspüren, als dies normalerweise vom Umfang der peripheren Einnahme erwartet wird. Menschen mit Fibromyalgie und anderen Schmerzzuständen, die durch Sensibilisierung gekennzeichnet sind, werden Schmerzen empfinden, von denen, deren Zustand nicht als Berührung bezeichnet wird “, fügte Clauw hinzu.

Aufgrund des Ursprungs von Fibromyalgie-Schmerzen im Zentralnervensystem sagte Clauw, dass Behandlungen mit Opioiden oder anderen narkotischen Schmerzmitteln normalerweise nicht wirksam sind, da sie die Aktivität von Neurotransmittern im Gehirn nicht verringern . “Diese Medikamente wurden bei Patienten mit Fibromyalgie nie als wirksam angesehen, und es gibt Anzeichen, dass Opioide die Fibromyalgie und andere Zustände zentralisierter Schmerzen sogar verschlimmern können”, sagte er.

Clauw empfiehlt Ärzten, pharmakologische Behandlungen wie Gabapentinoide, Tricyclika und Serotonin-Wiederaufnahmehemmer mit nicht-pharmakologischen Ansätzen wie kognitive Verhaltenstherapie, Bewegung und Stress abzubauen.


“Manchmal übertrifft das Ausmaß der Behandlungsreaktion für einfache, kostengünstige nicht medikamentöse Therapien die von Arzneimitteln”, sagte Clauw. “Der größte Vorteil ist eine verbesserte Funktion, die das Hauptziel der Behandlung von chronischen Schmerzen sein sollte. Die Mehrheit der Patienten mit Fibromyalgie kann eine Verbesserung ihrer Symptome feststellen und mit den richtigen Medikamenten und einem intensiven Einsatz nicht medikamentöser Therapien ein normales Leben führen. “


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