Fibromyalgie is een reumatische aandoening tweede meest voorkomende achter artrose en hoewel nog steeds op grote schaal verkeerd begrepen, wordt nu beschouwd als een aandoening van het centrale zenuwstelsel aan het leven, dat verantwoordelijk is voor de pijn versterkt dat door het lichaam schiet op degenen die lijden.

Daniel Clauw, MD, hoogleraar Anesthesiologie, University of Michigan, analyseerde de neurologische basis van fibromyalgie tijdens een plenaire zitting vandaag op de jaarlijkse wetenschappelijke bijeenkomst van de American Pain Society.

“Fibromyalgie kan worden beschouwd zowel als afzonderlijke ziekte en ook als een laatste gemeenschappelijke route van centralisatie en chronologie van pijn. De meeste mensen met deze aandoening hebben een geschiedenis van langdurige chronische pijn in hun lichaam “, zegt Clauw. “De aandoening kan moeilijk te diagnosticeren als men niet de klassieke symptomen weten, want er is geen enkele oorzaak en geen externe teken.”

Clauw uitgelegd dat de pijn van fibromyalgie is de hersenen en het ruggenmerg die gebieden van het lichaam waarin een persoon lijdt aan perifere pijn. De voorwaarde wordt geacht te zijn geassocieerd met stoornissen in de manier waarop de hersenen verwerken pijn en andere zintuiglijke informatie. Hij zei dat artsen moeten fibromyalgie bij patiënten met multifocale pijn (voornamelijk bewegingsapparaat) die niet volledig kan worden verklaard door verwonding of ontsteking vermoedt.


“Omdat de pijnbanen door het lichaam worden versterkt in fibromyalgie patiënten kan pijn overal voorkomen, waardoor chronische hoofdpijn, viscerale pijn en zintuiglijke overgevoeligheid komen vaak bij mensen die lijden aan deze pijnlijke aandoening, “zegt Clauw.

“Dit betekent niet dat het perifere nociceptieve ingang draagt ​​niet bij aan de pijn van patiënten met fibromyalgie lijden, maar ze voelen meer pijn dan wat normaal zou worden verwacht van de mate van perifere bijdrage. Mensen met fibromyalgie en andere staten van de pijn wordt gekenmerkt door het bewustzijn zal de pijn Vanaf dat degenen wier voorwaarde niet beschrijven als aanvoelen “, zegt Clauw.

Vanwege de oorsprong van het centrale zenuwstelsel van fibromyalgie pijn, Clauw dat behandeling met opioïden en andere narcotische analgetica in het algemeen niet effectief omdat ze de activiteit van neurotransmitters in de hersenen niet verminderen . “Deze drugs zijn nooit effectief bij patiënten met fibromyalgie beschouwd, en er zijn tekenen dat opioïden zelfs fibromyalgie en andere staten van centrale pijn zou kunnen verergeren,” zei hij.

Clauw adviseert artsen om farmacologische behandelingen te integreren, zoals gabapentinoids de trycycliques en remmers van serotonine heropname, met niet-farmacologische benaderingen, zoals cognitieve gedragstherapie, lichaamsbeweging en stress te verminderen.

“Soms is de schaal van de reactie op behandeling van eenvoudige en goedkope niet-geneesmiddel therapieën dat van geneesmiddelen,” zegt Clauw. “Het grootste voordeel is de verbeterde functie, die het belangrijkste doel van de behandeling van een chronische pijn zou moeten zijn. De meerderheid van de patiënten met fibromyalgie kan een verbetering van hun symptomen zien en een normaal leven leiden met de juiste medicijnen en intensief gebruik van niet-medicamenteuze behandelingen. “


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