La fibromialgia ahora se considera una enfermedad permanente del sistema nervioso central.

La fibromialgia es el segundo trastorno reumático más común detrás de la osteoartritis y, aunque todavía no se reconoce en gran medida, ahora se considera un trastorno del sistema nervioso central que es responsable del dolor amplificado desencadenado por el cuerpo en estos pacientes. . Daniel Clauw, MD, profesor de anestesiología en la Universidad de Michigan, analizó la base neurológica de la fibromialgia en una sesión plenaria dirigida hoy a la reunión científica anual de la American Pain Society.

“La fibromialgia puede verse como una enfermedad separada y como una vía final común para centralizar el dolor y la cronicidad. La mayoría de las personas con esta enfermedad tienen historias de dolor crónico a lo largo de sus vidas ”, dijo Clauw. “La afección puede ser difícil de diagnosticar si no conoce los síntomas clásicos porque no hay una causa única o un signo externo”.

Clauw explicó que el dolor de la fibromialgia proviene más del cerebro y la médula espinal que de áreas del cuerpo donde una persona puede experimentar dolor periférico. Se cree que esta enfermedad está asociada con trastornos en la forma en que el cerebro procesa el dolor y otra información sensorial. Agregó que los médicos deben sospechar fibromialgia en pacientes con dolor multifocal (especialmente musculoesquelético) que no se explica completamente por una lesión o inflamación.

“Dado que las vías del dolor en todo el cuerpo aumentan en los pacientes con fibromialgia, el dolor puede ocurrir en cualquier parte. Por lo tanto, los dolores de cabeza crónicos, el dolor visceral y la hiperreactividad sensorial son una condición dolorosa ”, dijo Clauw.

“Esto no significa que la entrada nociceptiva periférica no contribuya al dolor experimentado por los pacientes con fibromialgia, pero es más doloroso de lo que uno esperaría normalmente con el grado de entrada periférica”. Las personas con fibromialgia y otras afecciones sensibilizantes experimentarán un dolor que las personas sin la afección describirían como tocar ”, agregó Clauw.

Debido a los orígenes del dolor de la fibromialgia en el sistema nervioso central, Clauw dijo que los tratamientos con opioides u otros analgésicos narcóticos generalmente no son efectivos porque no reducen la actividad de los neurotransmisores en el cerebro. “Estos medicamentos nunca han demostrado ser efectivos en pacientes con fibromialgia, y hay evidencia de que los opioides pueden incluso empeorar la fibromialgia y otras condiciones de dolor centralizado”, dijo.

Cerebro de las neuronas en el fondo de la ciencia

Clauw aconseja a los médicos que integren tratamientos farmacológicos, como gabapentinoides, triplicos e inhibidores de la recaptación de serotonoína, con enfoques no farmacológicos como la terapia cognitivo-conductual, el ejercicio y la reducción del estrés.

“A veces, la magnitud de la respuesta al tratamiento de terapias no farmacológicas simples y económicas excede la de los medicamentos”, dijo Clauw. “El principal beneficio es la mejora de la función, que debería ser el objetivo principal del tratamiento de cualquier dolor crónico. La mayoría de los pacientes con fibromialgia pueden ver una mejora en sus síntomas y llevar una vida normal con los medicamentos adecuados y el uso intensivo de tratamientos no farmacológicos.

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