Nova pesquisa finalmente resolve o ‘mistério da fibromialgia’?

A pesquisa é real, mas não é nova nem afetou substancialmente o debate sobre a causa da doença.

Artem Furman / Shutterstock.com

Uma nova pesquisa descobriu que a verdadeira causa da fibromialgia é um número excessivo de nervos específicos encontrados perto de um tipo específico de vaso sanguíneo nas mãos e nos pés, encerrando a controvérsia sobre a causa e o mecanismo da doença.

O QUE É VERDADEIRO

Um estudo de 2013 publicado na revista Pain Medicine estudou as mãos de 24 pacientes do sexo feminino e descobriu um número excessivo de nervos específicos em torno de um tipo específico de vaso sanguíneo, insinuando uma possível causa física e identificável para a doença.

O QUE É FALSO

O estudo deixou de ser novo, apesar de ter sido anunciado como tal nos últimos cinco anos, nem mudou a visão científica predominante sobre a doença, que a maioria argumenta ser causada por uma maior sensibilização do sistema nervoso.

ORIGEM

Desde pelo menos  junho de 2013 , um artigo quase idêntico apareceu em vários sites com a manchete “Fibromyalgia Mystery Finally Solved!”. Essas histórias, que continuam a aparecer on-line, começam com a mesma alegação:

Pesquisadores descobriram a principal fonte de dor em pacientes com fibromialgia e, ao contrário do que muitos acreditam, ela não provém do cérebro. As descobertas marcam o fim de um mistério de décadas sobre a doença, que muitos médicos acreditavam ser conjurada na imaginação dos pacientes. […]

Até recentemente, muitos médicos pensavam que a doença era “imaginária” ou psicológica, mas os cientistas agora revelaram que a principal fonte de dor provém de um local pouco provável – excesso de vasos sanguíneos nas mãos, pernas e pé.

A fibromialgia é uma condição enigmática que afeta desproporcionalmente as mulheres; está associada a dor clinicamente inexplicada, potencialmente combinada com outros sintomas de origem médica desconhecida. Conforme  relatado  em um artigo de revisão de 2014 no  Journal of the American Medical Association:

A fibromialgia pode ser considerada como um diagnóstico discreto ou como uma constelação de sintomas caracterizados pela amplificação da dor do sistema nervoso central com fadiga concomitante, problemas de memória e distúrbios do sono e do humor.

Antes de mergulhar nas alegações de pesquisa feitas nesta marca de clickbait da “fibromialgia resolvida”, é importante mencionar que enquadrar a questão como um debate entre aqueles que pensam que a dor é “imaginária” e aqueles que pensam que é “real” é um descrição extremamente redutora das hipóteses médicas que cercam a fibromialgia e, de fato, da própria dor.

A explicação mais comum para os sintomas que se apresentam como fibromialgia na literatura científica é um fenômeno apelidado de “sensibilização central”, em que o sistema nervoso central (seja através de trauma físico ou outra causa) reduz seu limiar para registrar sinais externos como dor. Conforme descrito em uma  revisão de 2009  :

Em vez de [ser causada por um fator externo], a sensibilização central representa um estado anormal de responsividade ou aumento do ganho do sistema nociceptivo [a parte do sistema nervoso sensorial que envia  sinais de dor ]. A dor é efetivamente gerada como conseqüência de mudanças no sistema nervoso central que alteram a forma como ela responde aos estímulos sensoriais, em vez de refletir a presença de uma fonte física de dor.

Enquanto a sensibilização central pode não ter uma fonte externa, a dor não é mais “real” ou “imaginária” do que qualquer outra dor causada por um estímulo físico real.

O  estudo  referenciado nas histórias virais, publicado em 2013 na revista  Pain Medicine,  defende uma fonte física e detectável da condição. O estudo se concentrou em um tipo específico de vaso sangüíneo nas derivações de vênulas mão-arteríola – que pode direcionar o fluxo sanguíneo para contornar as mãos em resposta à temperatura, como descrito em um comunicado de imprensa  da Universidade de Albany de 2013  , onde a pesquisa foi conduzida. :

Nos seres humanos, esses tipos de derivações são exclusivos para as palmas das nossas mãos e solas dos pés, que funcionam como o radiador de um carro. Sob condições quentes, os desvios se fecham para forçar o sangue para os capilares na superfície da pele, a fim de irradiar calor do corpo, e nossas mãos ficam suadas. Sob condições frias, os desvios abrem-se permitindo que o sangue contorne os capilares para conservar o calor, e nossas mãos esfriam e calçam luvas.

Os pesquisadores, que também estavam associados a uma empresa de biotecnologia (INTiDYN) que desenvolveu a técnica de imagem usada no estudo, analisaram biópsias de 24 pacientes com fibromialgia e as compararam a um número de controles saudáveis. Os autores descobriram que havia um número excessivo de nervos em torno desses shunts nas mãos do paciente com fibromialgia. O autor sênior no papel, Frank Rice, explicou o significado potencial dos resultados em seu comunicado de imprensa:

“Em vez de estar no cérebro, a patologia consiste em fibras nervosas sensoriais excessivas ao redor de estruturas especializadas de vasos sanguíneos localizadas nas palmas das mãos”, disse Rice, presidente da Intidyn e pesquisador sênior do estudo. “Esta descoberta fornece evidências concretas de uma patologia específica da fibromialgia, que agora pode ser usada para diagnosticar a doença, e como um novo ponto de partida para o desenvolvimento de terapias mais eficazes.”

Além de fornecer uma explicação para a dor da fibromialgia, os autores sugerem que esse mecanismo também pode estar relacionado a outros sintomas comumente associados à condição:

Em primatas humanos e não humanos, a [pele sem pêlos encontrada nas mãos e pés] desempenha um papel importante na termorregulação e na manutenção da temperatura corporal central, bem como na distribuição de sangue a outros órgãos, como músculo esquelético durante períodos de alta taxa metabólica. exigem.

Portanto, [um excesso de nervos próximos a derivações de vênulas de arteríola na pele livre de pêlos nas mãos de pacientes com fibromialgia] pode contribuir para extrema sensibilidade e dor nas mãos, mas também pode contribuir para a dor profunda, fadiga, distúrbios do sono crônicos e disfunção cognitiva associada a [fibromialgia].

Enquanto o estudo é real, foi limitado em seu escopo devido ao seu baixo tamanho amostral. Além disso, não parece ter desviado o debate das hipóteses que giram principalmente em torno da sensibilização central, apesar das alegações de que o mistério havia sido “resolvido”. Uma  revisão de 2015   sobre a condição liberada pela Clínica Mayo descreve o estado do campo:

Anteriormente, havia alguma dúvida sobre se havia uma “base orgânica” para essas condições relacionadas, mas hoje há evidências irrefutáveis ​​de imagens cerebrais e outras técnicas de que essa condição tem fortes bases biológicas, embora fatores psicológicos, sociais e comportamentais claramente atuem. papéis proeminentes em alguns pacientes. A característica patofisiológica é um sistema nervoso central sensibilizado ou hiperativo que leva a um aumento do controle de volume ou ganho de dor e processamento sensorial.

Embora o estudo seja real e seus resultados específicos não estejam em questão, ele não era novo a partir de 2017, nem alterou substancialmente o debate sobre a causa da fibromialgia, muito menos “resolver o mistério”. Como tal, classificamos a reivindicação como falsa.

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