Letztendlich wurde Fibromyalgie als lebenslange Störung des zentralen Nervensystems betrachtet

Fibromyalgie ist die zweithäufigste rheumatische Erkrankung nach Arthrose und wird, obwohl immer noch weithin missverstanden, als lebenslange Störung des zentralen Nervensystems angesehen, die für den verstärkten Schmerz verantwortlich ist, der durch den Körper schießt bei denen, die darunter leiden. Daniel Clauw, MD, Professor für Anästhesiologie an der University of Michigan, analysierte heute in einer Plenarsitzung auf der jährlichen wissenschaftlichen Sitzung der American Pain Society die neurologischen Grundlagen für Fibromyalgie.

 

“Fibromyalgie kann sowohl als diskrete Erkrankung als auch als gemeinsamer Endweg für Zentralisationsschmerz und Chronifizierung betrachtet werden. Die meisten Menschen mit dieser Erkrankung haben lebenslange Geschichten über chronische Schmerzen im ganzen Körper “, sagte Clauw. “Der Zustand kann schwierig zu diagnostizieren sein, wenn man mit klassischen Symptomen nicht vertraut ist, weil es keine einzige Ursache und keine äußeren Anzeichen gibt.”

Clauw erklärte, dass der Schmerz bei Fibromyalgie mehr vom Gehirn und vom Rückenmark ausgeht als von Körperbereichen, in denen jemand periphere Schmerzen haben kann. Man nimmt an, dass der Zustand mit Veränderungen in der Verarbeitung von Schmerz und anderen sensorischen Informationen im Gehirn zusammenhängt. Er sagte, Ärzte sollten bei Patienten mit multifokaler Fibromyalgie (meist muskuloskelettalen) Schmerzen vermuten, die nicht vollständig durch Verletzungen oder Entzündungen erklärt werden können.

“Da bei Patienten mit Fibromyalgie die Schmerzwege im gesamten Körper verstärkt werden, können Schmerzen überall auftreten. Daher sind chronische Kopfschmerzen, viszerale Schmerzen und sensorische Überempfindlichkeitsreaktionen bei Menschen mit dieser Erkrankung üblich. schmerzhafter Zustand “, sagte Clauw.

“Dies bedeutet nicht, dass der periphere nozizeptive Input nicht zu den Schmerzen bei Patienten mit Fibromyalgie beiträgt, aber ich fühle mehr Schmerz, als normalerweise vom Umfang des peripheren Inputs erwartet würde. Menschen mit Fibromyalgie und anderen Schmerzzuständen, die durch Sensibilisierung gekennzeichnet sind, werden Schmerzen empfinden, die diejenigen, die diese Erkrankung nicht haben, als Berührung bezeichnen würden “, fügte Clauw hinzu.

Aufgrund der Ursachen der Schmerzen des Zentralnervensystems bei Fibromyalgie sagte Clauw, Opioidbehandlungen oder andere narkotische Analgetika seien normalerweise nicht wirksam, da sie die Aktivität von Neurotransmittern im Gehirn nicht beeinträchtigen. “Diese Medikamente haben sich bei Patienten mit Fibromyalgie nicht als wirksam erwiesen, und es gibt Hinweise darauf, dass Opioide Fibromyalgie und andere zentralisierte Schmerzzustände sogar verschlimmern können”, sagte er.

Clauw empfiehlt Ärzten, pharmakologische Behandlungen wie Gabapentinoide, Tricyclika und selektive Serotonin-Wiederaufnahmehemmer mit nicht-pharmakologischen Ansätzen wie kognitive Verhaltenstherapie, Bewegung und Stressreduktion zu integrieren.

“Manchmal übertrifft das Ausmaß der Reaktion auf die Behandlung einfacher und kostengünstiger nichtpharmakologischer Therapien die von Arzneimitteln”, sagte Clauw. “Der größte Vorteil ist die Funktion, die das Hauptziel der Behandlung eines chronischen Schmerzzustands sein sollte. Die Mehrheit der Patienten mit Fibromyalgie kann eine Verbesserung ihrer Symptome feststellen und mit den geeigneten Medikamenten und einem umfangreichen Einsatz nicht-pharmakologischer Therapien ein normales Leben führen. “

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