Het onderzoek is echt, maar het is niet nieuw en heeft ook geen substantiële invloed gehad op het debat over de oorzaak van de ziekte.
Nieuw onderzoek heeft aangetoond dat de echte oorzaak van fibromyalgie een overmaat aan specifieke zenuwen is, gevonden in de buurt van een specifiek soort bloedvat in de handen en voeten, waarmee de controverse over de oorzaak en het mechanisme van de ziekte wordt beëindigd.
WAT IS WAAR
Een in 2013 gepubliceerde studie in Pain Medicine bestudeerde de handen van 24 vrouwelijke patiënten en ontdekte een overschot aan specifieke zenuwen rond een specifiek soort bloedvat, wat duidt op een mogelijke fysieke en identificeerbare oorzaak van de ziekte.
WAT IS NIET WAAR
Het onderzoek is niet langer nieuw, ondanks dat het de afgelopen vijf jaar als zodanig is gefactureerd, noch heeft het de heersende wetenschappelijke opvatting over de ziekte veranderd, waarvan de meeste bewering wordt veroorzaakt door een verhoogde sensitisatie van het zenuwstelsel.
OORSPRONG
Sinds minstens juni 2013 is een bijna identiek artikel verschenen op een aantal websites met de kop “Fibromyalgia Mystery Finally Solved!” Deze verhalen, die nog steeds online verschijnen, beginnen met dezelfde claim:
Onderzoekers hebben de grootste pijnbron gevonden bij fibromyalgiepatiënten en in tegenstelling tot wat velen denken, komt het niet van de hersenen. De bevindingen markeren het einde van een decennia-oud mysterie over de ziekte, waarvan veel artsen dachten dat ze in de verbeelding van de patiënt werden opgeroepen. […]
Tot voor kort dachten veel artsen dat de ziekte “denkbeeldig” of psychologisch was, maar wetenschappers hebben nu onthuld dat de belangrijkste bron van pijn voortkomt uit een zeer onwaarschijnlijke plaats – overtollige bloedvaten in de hand, benen en voeten.
Fibromyalgie is een raadselachtige aandoening die vrouwen onevenredig aantast; het is geassocieerd met klinisch onverklaarbare pijn, mogelijk in combinatie met andere symptomen van onbekende medische oorsprong. Zoals gemeld in een beoordelingsdocument uit 2014 in het Journal of the American Medical Association:
Fibromyalgie kan worden beschouwd als een afzonderlijke diagnose of als een constellatie van symptomen die worden gekenmerkt door pijnamplificatie van het centrale zenuwstelsel met gelijktijdige vermoeidheid, geheugenproblemen en slaap- en stemmingsstoornissen.
Voordat we duiken in de onderzoeksclaims die we hebben gedaan in dit merk van clickbait met “fibromyalgie”, is het belangrijk om te vermelden dat het framen van het probleem als een debat tussen degenen die denken dat de pijn “ingebeeld” is en degenen die denken dat het “echt” is, een extreem reductieve beschrijving van de medische hypothesen rond fibromyalgie en, inderdaad, van pijn zelf.
De meest voorkomende verklaring voor de symptomen die aanwezig zijn als fibromyalgie in de wetenschappelijke literatuur is een fenomeen dat “centrale sensitisatie” wordt genoemd, waarbij het centrale zenuwstelsel (hetzij door fysiek trauma of een andere oorzaak) de drempel voor het registreren van externe signalen als pijn verlaagt. Zoals beschreven in een recensie uit 2009 :
In plaats daarvan [veroorzaakt door een externe factor], vertegenwoordigt centrale sensitisatie een abnormale staat van reactievermogen of toegenomen winst van het nociceptieve systeem [het deel van het sensorische zenuwstelsel dat pijnsignalen uitzendt ]. De pijn wordt effectief opgewekt als gevolg van veranderingen binnen het [centrale zenuwstelsel] die vervolgens de manier waarop het reageert op sensorische inputs verandert in plaats van de aanwezigheid van [een fysieke pijnbron] te weerspiegelen.
Hoewel centrale sensitisatie mogelijk geen externe bron heeft, is de pijn niet meer “reëel” of “denkbeeldig” dan enige andere pijn veroorzaakt door een daadwerkelijke fysieke stimulus.
De studie waarnaar wordt verwezen in de virale verhalen, gepubliceerd in 2013 in het tijdschrift Pain Medicine, maakt een argument voor een fysieke, detecteerbare bron van de aandoening. De studie richtte zich op een specifiek soort bloedvat in de hand – arteriole venule shunts – dat de bloedstroom kan leiden om de handen te omzeilen als reactie op temperatuur, zoals beschreven in een 2013 persbericht
Bij mensen zijn dit soort shunts uniek voor de handpalmen en voetzolen die werken als de radiator in een auto. Onder warme omstandigheden sluiten de shunts af om bloed in de haarvaten naar het oppervlak van de huid te dringen om warmte uit het lichaam te laten ontsnappen, en onze handen worden bezweet. Onder koude omstandigheden openen de shunts zich wijd waardoor bloed de capillairen kan omzeilen om warmte te besparen, en onze handen verkouden worden en handschoenen aantrekken.
De onderzoekers, die ook werden geassocieerd met een biotech-bedrijf (INTiDYN) dat de in het onderzoek gebruikte beeldvormingstechniek ontwikkelde, analyseerden biopsieën van 24 vrouwelijke patiënten met fibromyalgie en vergeleken deze met een aantal gezonde controlepersonen. De auteurs ontdekten dat er een aanzienlijk overschot aan zenuwen rond deze shunts aanwezig was in de handen van de fibromyalgiepatiënten. De senior auteur op papier, Frank Rice, legde de potentiële betekenis van de bevindingen in hun persbericht uit:
“In plaats van in de hersenen aanwezig te zijn, bestaat de pathologie uit buitensporige sensorische zenuwvezels rond gespecialiseerde bloedvatstructuren in de handpalmen”, aldus Dr. Rice, President van Intidyn en senior onderzoeker van het onderzoek. “Deze ontdekking levert concreet bewijs voor een fibromyalgie-specifieke pathologie die nu kan worden gebruikt voor de diagnose van de ziekte, en als een nieuw startpunt voor de ontwikkeling van effectievere therapieën.”
Behalve dat ze een verklaring bieden voor fibromyalgiepijn, suggereren de auteurs dat dit mechanisme ook verband kan houden met andere symptomen die vaak geassocieerd worden met de aandoening:
Bij menselijke en niet-menselijke primaten speelt de [haarvrije huid op de handen en voeten] een belangrijke rol bij thermoregulatie en het in stand houden van de kerntemperatuur van het lichaam, evenals de verdeling van bloed naar andere organen zoals skeletspier tijdens perioden met hoge metabole werking. vraag naar.
Daarom [een teveel aan zenuwen nabij arteriole venule shunts in de haarvrije huid op de handen van fibromyalgie] kunnen patiënten bijdragen tot extreme gevoeligheid en pijn in de handen, maar kunnen ook bijdragen aan de chronische wijdverspreide diepe pijn, vermoeidheid, slaapstoornissen en cognitieve disfunctie geassocieerd met [fibromyalgie].
Hoewel het onderzoek reëel is, was het beperkt vanwege de lage steekproefomvang. Verder lijkt het debat niet te zijn afgeweken van hypothesen die in de eerste plaats draaien rond centrale sensitisatie, ondanks beweringen dat het mysterie “opgelost” was. Een beoordeling van 2015 op de voorwaarde vrijgegeven door de Mayo Clinic beschrijft de staat van het veld:
Eerder was er enige twijfel over of er een “organische basis” was voor deze gerelateerde aandoeningen, maar vandaag is er onweerlegbaar bewijs van hersenbeelden en andere technieken dat deze aandoening een sterke biologische basis heeft, hoewel psychologische, sociale en gedragsfactoren duidelijk spelen prominente rollen bij sommige patiënten. Het pathofysiologische kenmerk is een gesensibiliseerd of hyperactief centraal zenuwstelsel dat leidt tot een verhoogde volumeregeling of winst op pijn en sensorische verwerking.
Hoewel de studie echt is en hun specifieke resultaten niet in het geding zijn, was deze niet nieuw vanaf 2017, en veranderde ze ook niet wezenlijk het debat over de oorzaak van fibromyalgie, laat staan ”het mysterie oplossen”. Als zodanig rangschikken we de claim als grotendeels fout.
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