Il rischio di vertigini e cadute nella fibromialgia

Di Adrienne Dellwo 

Nella fibromialgia, vertigini, mancanza di equilibrio e cadute sono lamentele comuni. Per alcune persone, sono un fastidio minore che si presenta occasionalmente. In altri, possono essere gravemente debilitanti e causare lesioni regolari.

La caduta, e specialmente la frequente caduta, è un problema serio. L’ultima cosa di cui hai bisogno quando hai già un dolore costante è ferirti tutto il tempo. Cadute frequenti o problemi di equilibrio possono anche portare alla paura di cadere.

Ese miedo puede, a su vez, hacer que tengas miedo de permanecer activo, incluso dentro de tus límites. De acuerdo con un estudio en  Reumatología Clínica, el  73 por ciento de las personas con fibromialgia tienen miedo a la actividad física, y casi el 75 por ciento tiene problemas con el equilibrio.

La caída es menos un síntoma y más una consecuencia de los síntomas de mareos y falta de equilibrio. En esta condición, las caídas y los problemas de equilibrio también pueden estar relacionados con cambios en la forma en que caminamos.

Entonces, ¿por qué la fibromialgia involucra estos problemas? ¿Y qué podemos hacer al respecto?

Fibromialgia y mareos

Nella fibromialgia, le vertigini si verificano più frequentemente quando ti alzi per la prima volta. È simile alla sensazione di “andare di testa” quando ti alzi troppo in fretta, può accadere solo ogni volta che ti corichi o ti alzi in piedi. L’improvviso insorgere di vertigini può indurlo a dondolarsi sui piedi, oscillare o addirittura farlo cadere o svenire.

El mareo y el desmayo en esta condición pueden estar relacionados con un subgrupo en particular, según un estudio de 2017 publicado en el  European Journal of Pain . Además de los mareos y los desmayos, este subgrupo también tenía los niveles más altos de dolor, así como una variedad de síntomas y condiciones que se superponen, incluida la disfunción cognitiva (“fibro niebla”), vejiga irritable, vulvodinia y síndrome de piernas inquietas.

La investigación sugiere que este síntoma se debe a una disfunción del sistema nervioso autónomo (SNA), que se llama disautonomía. El SNA está involucrado con muchas funciones críticas en su cuerpo, incluyendo frecuencia cardíaca, presión arterial, frecuencia respiratoria, temperatura corporal, metabolismo y digestión.

Le vertigini causate dalla disautonomia possono essere chiamate intolleranza ortostatica, ipotensione neurale mediata o sindrome da tachicardia ortostatica posturale (POTS). Essenzialmente, queste cose significano che il cuore e il cervello non comunicano correttamente tra loro.

Ciò che dovrebbe accadere è che quando si alza da una posizione sdraiata o seduta, l’SNA aumenta la pressione del sangue per combattere la gravità e mantenere una quantità sufficiente di sangue nel cervello. Con la disautonomia, questo non accade come dovrebbe. Invece, la pressione sanguigna può effettivamente scendere quando si è in piedi, e il risultato è vertigini o vertigini. In POTS, la frequenza cardiaca accelera quando la pressione sanguigna scende.

Le vertigini possono essere associate a palpitazioni cardiache, visione offuscata, aumento della frequenza cardiaca, dolore al petto e un tipo di svenimento chiamato sincope vasovagale.

Tuttavia, non tutti i soggetti con vertigini associati alla fibromialgia svengono. In uno studio del 2008, i ricercatori affermano che vertigini e palpitazioni erano più comuni dei svenimenti. Dicono anche che POTS è stato uno dei sintomi più comuni di fibromialgia che hanno osservato durante i test di tabella inclinati, che misurano la loro risposta ai cambiamenti di posizione.

Equilibrio e problemi di andatura

Oltre alla possibilità di cadute, la ricerca suggerisce che le persone con fibromialgia camminano in modo diverso dalle persone sane. Uno studio del 2009 ha rilevato che circa il 28% delle persone con questa malattia ha un’andatura anormale (modo di camminare).

In uno studio di performance funzionale del 2017, i ricercatori hanno affermato che l’andatura e l’equilibrio sono stati gravemente danneggiati in questa condizione. Le differenze includono:

  • Lunghezza del passo significativamente più breve
  • Passo lento
  • Il modo in cui il corpo oscilla quando si cammina.

I ricercatori hanno osservato che le differenze nell’andatura e nell’equilibrio erano peggiori nelle persone che avevano più dolore, rigidità, affaticamento, ansia e depressione. Hanno raccomandato ai medici di valutare il progresso e la posizione dei loro pazienti con fibromialgia per trovare il miglior tipo di riabilitazione e prevenzione delle cadute per loro.

Questo studio fa parte di un corpo crescente di letteratura scientifica che dimostra problemi di equilibrio e di andatura in questa condizione che può portare a cadute. Tuttavia, la valutazione e il trattamento di questi sintomi potrebbero non essere una priorità elevata per il medico. Se sei preoccupato, assicurati di menzionarli al tuo prossimo appuntamento.

Alleviare il capogiro e il rischio di cadute nella fibromialgia

Più hai successo nel trattamento della fibromialgia, meno questi sintomi dovrebbero essere un problema. Tuttavia, se hai bisogno di maggiore attenzione o se non sei stato in grado di trovare trattamenti efficaci per la fibromialgia, hai diverse opzioni.

Per capogiri POTS, ipotensione ortostatica o ipotensione cerebrale mediata, il medico può raccomandare farmaci che aiutano. Questi possono includere SSRI / SNRI, benzodiazepine e beta-bloccanti. Alcuni di questi farmaci possono anche aiutare ad alleviare altri sintomi della fibromialgia: SSRI e SNRI sono comunemente prescritti per questa malattia. Il medico può anche raccomandare cambiamenti nello stile di vita.

Se fumi, la ricerca pubblicata nella rivista di reumatologia   congiunta, Bone, suggerisce che smettere di fumare può aiutare ad alleviare lo svenimento e altri sintomi di fibromialgia.

Quando si tratta di equilibrio e andatura, la terapia fisica è un trattamento comune. Puoi anche chiedere al tuo dottore se qualcosa come yoga, tai chi o qigong è sicuro per te.

Fino a quando non trovi modi per migliorare questi sintomi, vale la pena fare attenzione. Dispositivi ausiliari, come una canna o un deambulatore, possono aiutarti a rimanere in piedi. Gli esercizi seduti possono essere l’opzione più sicura e sono sicuramente un’opzione migliore rispetto ad essere meno attivi di quanto si possa essere.

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