A síndrome de fibromialgia e a dor miofascial geralmente andam de mãos dadas. Devido à sobreposição frequente e a certos sintomas semelhantes, eles costumam ser confundidos com a mesma condição e, portanto, as pessoas com os dois às vezes são diagnosticadas e tratadas apenas para um.
Este é um problema real, por três razões principais:
- requer tratamento diferente
- Os pontos de gatilho MPS podem ser eliminados
- A dor da MPS pode exacerbar a síndrome de fibromialgia e a diminuição da dor da MPS pode aliviar significativamente os sintomas da síndrome de fibromialgia
Alguns pesquisadores usam o nome de “dor miofascial crônica” (CMP) em vez de síndrome da dor miofascial por causa da evidência de que é uma doença, não uma síndrome. (Uma “síndrome” é um conjunto de sintomas sem causa conhecida).
Apresentação
Na MPS, os músculos e tecidos conjuntivos (que compõem a fáscia) desenvolvem o que é chamado de ponto de gatilho (PG). Que eles não são não o mesmo que pontos FMS concurso.
Um ponto de gatilho é um pequeno nó duro que às vezes você pode sentir sob a pele. O nó em si pode doer, especialmente quando coça, mas geralmente causa dor em outra área, chamada de dor referida.
Os pontos de gatilho geralmente se formam como resultado de trauma do tecido. Os especialistas não sabem por que o dano que normalmente cura na maioria das pessoas causa pontos de gatilho em outras. No entanto, estudos sugerem que o dano muscular em algumas pessoas resulta em anormalidades onde as células nervosas se conectam às células musculares. Isso sugere que a MPS é uma doença neuromuscular.
Associação
O motivo pelo qual as pessoas com MPS freqüentemente desenvolvem SFM ainda não está claro, mas um conjunto crescente de evidências mostra que, em algumas pessoas, a dor crônica pode perturbar o sistema nervoso central, levando à sensibilização central. Se as teorias estiverem corretas, o tratamento precoce da MPS pode ajudar a prevenir a SFM.
Um termo genérico emergente para SFM, MPS e outras condições envolvendo sensibilização central é a síndrome da sensibilidade central.
Sintomas
Alguns sintomas associados à MPS são semelhantes aos sintomas associados à SFM, enquanto outros estão relacionados a apenas um.
Os sintomas comuns incluem:
- dor nos tecidos moles variando de leve a grave
- dor de cabeça e / ou enxaquecas
- sono perturbado
- problemas de equilíbrio e / ou tontura
- zumbido (zumbido nos ouvidos) e dor de ouvido
- problemas de memória
- suor inexplicável
- agravamento dos sintomas devido ao estresse, mudanças climáticas / extremas e atividade física
Os sintomas associados com MPS, mas não FMS incluem:
- dormência nos membros
- estalando ou clicando nas juntas
- amplitude limitada de movimento nas articulações, especialmente na mandíbula
- visão turva ou dupla
- náusea inexplicável
Os sintomas associados com FMS, mas não MPS incluem:
- fadiga
- ataques de pânico
- sentindo-se oprimido devido aos altos níveis de entrada sensorial
- alergias e sensibilidades
- confusão e desorientação periódicas
Para mais sintomas de fibromialgia, consulte a lista monstruosa de sintomas de fibromialgia.
Diagnóstico
A dor referida torna a MPS particularmente difícil de diagnosticar e tratar. Normalmente, o médico diz: “Onde dói?” Em seguida, olha para onde ele está apontando. Para tratar a MPS, você e seu médico devem examinar seus sintomas e determinar onde estão seus gatilhos.
Seu médico pode encontrar pontos de gatilho para o toque ou com base nos sintomas.
Testes como elastografia por ressonância magnética e biópsia de tecido podem mostrar anormalidades nos pontos-gatilho, mas seus papéis no diagnóstico da MPS ainda não estão claros.
No entanto, nenhum teste ou varredura revela anormalidades nos tecidos onde as pessoas com SFM sentem dor.
Promoções
Você tem várias opções para o tratamento da MPS:
- Injeções no ponto de gatilho: o médico insere uma agulha diretamente em um PG ou em vários lugares ao redor dele para soltar as faixas apertadas. O médico pode injetar um analgésico, como corticosteroides ou lidocaína. (Observação: alguns médicos acreditam que os corticosteroides podem exacerbar os sintomas da fibromialgia.) Quando nenhum medicamento é usado, é chamado de agulha seca.
- Acupuntura: a acupuntura é uma prática chinesa antiga semelhante ao agulhamento seco. Embora os estudos sobre seu uso na MPS sejam limitados, eles são promissores e muitos pacientes e médicos relatam bons resultados.
- Fisioterapia: um tipo especial de terapia chamado spray e alongamento é comum para tratar a MPS. Um fisioterapeuta o orienta durante os exercícios de alongamento enquanto pulveriza uma substância entorpecente nos músculos. O terapeuta também pode usar certas técnicas de massagem para relaxar os músculos e pontos-gatilho. Além disso, um terapeuta pode trabalhar com você em fatores como postura inadequada que podem contribuir para a MPS.
- Medicamentos – medicamentos comuns para MPS incluem antiinflamatórios não esteroidais (AINEs), como Aleve (naproxeno) ou ibuprofeno, como Advil e Motrin, e antidepressivos tricíclicos, como amitriptilina, doxepina e nortriptilina.
Tratamentos MPS vs tratamentos FMS
Novamente, existem sobreposições, mas também existem diferenças importantes. Os tratamentos usados para MPS e FMS incluem:
- acupuntura
- fisioterapia (embora em diferentes formas)
- antidepressivos tricíclicos (embora os antidepressivos SSRI / SNRI estejam se tornando mais comuns para FMS)
Estudos mostram que as injeções nos pontos de gatilho não são eficazes no alívio dos pontos sensíveis da fibromialgia, e os AINEs não são eficazes no tratamento da dor da SFM.
Para obter mais informações sobre os tratamentos da fibromialgia, consulte Tratamento da fibromialgia, Uma abordagem multidisciplinar.
Fazer frente
Com diferenças significativas em seus sintomas, diagnósticos e tratamentos, está claro que a fibromialgia e a síndrome da dor miofascial não são a mesma condição. No entanto, pode ser extremamente difícil determinar qual condição causa que dor quando uma pessoa tem os dois.
Trabalhando sozinho e com seu médico e / ou fisioterapeuta, você pode determinar onde você tem pontos de gatilho e como tratá-los da melhor maneira sem piorar a fibromialgia. O alívio da dor miofascial provavelmente aliviará os sintomas da fibromialgia, portanto, você pode ver um benefício duplo.
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