El síndrome de fibromialgia y dolor miofascial a menudo van de la mano. Debido a la frecuente superposición y ciertos síntomas similares, a menudo se confunden con la misma condición y, por lo tanto, las personas con ambos a veces solo son diagnosticadas y tratadas por una.
Este es un problema real, por tres razones principales:
- requieren un tratamiento diferente
- Se pueden eliminar los puntos gatillo MPS
- El dolor MPS puede exacerbar el síndrome de fibromialgia y la disminución del dolor MPS puede calmar significativamente los síntomas del síndrome de fibromialgia
Algunos investigadores usan el nombre de “dolor miofascial crónico” (CMP) en lugar de síndrome de dolor miofascial debido a la evidencia de que es una enfermedad, no un síndrome. (Un “síndrome” es un conjunto de síntomas sin causa conocida).
Presentación
En MPS, los músculos y los tejidos conectivos (que forman la fascia) desarrollan lo que se llama un punto gatillo (TrP). Que no son no lo mismo que los puntos FMS licitación.
Un punto gatillo es un pequeño nudo duro que a veces puedes sentir debajo de tu piel. El nudo en sí puede ser doloroso, especialmente cuando está picado, pero a menudo causa dolor en otra área, llamada dolor referido.
Los puntos de activación generalmente se forman como resultado de un traumatismo tisular. Los expertos no saben por qué el daño que normalmente cura en la mayoría de las personas provoca puntos de activación en otros. Sin embargo, los estudios sugieren que el daño muscular en algunas personas produce anormalidades donde las células nerviosas se conectan a las células musculares. Esto sugiere que MPS es una enfermedad neuromuscular.
Asociación
La razón por la cual las personas con MPS con frecuencia desarrollan FMS aún no está clara, pero un creciente cuerpo de evidencia muestra que, en algunas personas, el dolor crónico puede alterar el sistema nervioso central, lo que lleva a la sensibilización central. Si las teorías son correctas, el tratamiento temprano de MPS puede ayudar a prevenir el FMS.
Un término genérico emergente para FMS, MPS y otras afecciones que implican sensibilización central es el síndrome de sensibilidad central.
Síntomas
Algunos síntomas asociados con MPS son similares a los síntomas asociados con FMS, mientras que otros están relacionados con uno solo.
Los síntomas que tienen en común incluyen:
- dolor de tejidos blandos que varía de leve a intenso
- dolor de cabeza y / o migrañas
- sueño perturbado
- problemas de equilibrio y / o mareos
- tinnitus (zumbido en los oídos) y dolor de oído
- problemas de memoria
- sudoración inexplicable
- empeoramiento de los síntomas debido al estrés, cambios climáticos / extremos y actividad física
Los síntomas asociados con MPS pero no con FMS incluyen:
- entumecimiento en las extremidades
- estallar o hacer clic en las articulaciones
- rango de movimiento limitado en las articulaciones, especialmente la mandíbula
- visión doble o borrosa
- náuseas inexplicables
Los síntomas asociados con FMS pero no con MPS incluyen:
- fatiga
- ataques de pánico
- sentirse abrumado debido a los altos niveles de información sensorial
- alergias y sensibilidades
- confusión y desorientación periódicas
Para más síntomas de fibromialgia, vea la lista monstruosa de síntomas de fibromialgia.
Diagnóstico
El dolor referido hace que la MPS sea particularmente difícil de diagnosticar y tratar. Por lo general, un médico dice: “¿Dónde duele?”, Luego mira hacia dónde está apuntando. Para tratar la MPS, usted y su médico deben examinar sus síntomas y determinar dónde están sus puntos desencadenantes.
Su médico puede encontrar puntos gatillo para el tacto o en función de los síntomas.
Las pruebas como la elastografía de resonancia magnética y la biopsia de tejido pueden mostrar anormalidades en los puntos gatillo, pero sus funciones en el diagnóstico de MPS aún no están claras.
Sin embargo, ninguna prueba o exploración revela anormalidades en los tejidos donde las personas con FMS experimentan dolor.
Tratos
Tiene varias opciones para tratar MPS:
- Inyecciones en el punto de activación: el médico inserta una aguja directamente en un TrP o en varios lugares a su alrededor para aflojar las bandas apretadas. El médico puede inyectar un analgésico, como corticosteroides o lidocaína. (Nota: algunos médicos creen que los corticosteroides pueden exacerbar los síntomas de la fibromialgia). Cuando no se usa ningún medicamento, se llama punción seca.
- Acupuntura: la acupuntura es una práctica china antigua similar a la punción seca. Aunque los estudios sobre su uso en MPS son limitados, son prometedores y muchos pacientes y profesionales reportan buenos resultados.
- Fisioterapia: un tipo especial de terapia llamada pulverización y estiramiento es común para tratar la MPS. Un fisioterapeuta lo guía a través de ejercicios de estiramiento mientras rocía una sustancia adormecedora en su músculo. El terapeuta también puede usar ciertas técnicas de masaje para relajar los músculos y los puntos gatillo. Además, un terapeuta puede trabajar con usted en factores como la mala postura que pueden contribuir a la MPS.
- Medicamentos: los medicamentos comunes para MPS incluyen medicamentos antiinflamatorios no esteroideos (AINE) como Aleve (naproxeno) o medicamentos con ibuprofeno como Advil y Motrin, y antidepresivos tricíclicos como amitriptilina, doxepina y Nortriptilina.
Tratamientos MPS vs tratamientos FMS
Una vez más, hay superposiciones, pero también hay diferencias importantes. Los tratamientos utilizados para MPS y FMS incluyen:
- acupuntura
- fisioterapia (aunque en diferentes formas)
- antidepresivos tricíclicos (aunque los antidepresivos SSRI / SNRI se están volviendo más comunes para FMS)
Los estudios demuestran que las inyecciones en los puntos gatillo no son efectivas para aliviar los puntos sensibles de la fibromialgia, y los AINE no son efectivos en el tratamiento del dolor de FMS.
Para obtener más información sobre los tratamientos para la fibromialgia, consulte Tratamiento de la fibromialgia, un enfoque multidisciplinario.
Hacer frente
Con diferencias significativas en sus síntomas, diagnósticos y tratamientos, está claro que la fibromialgia y el síndrome de dolor miofascial no son la misma condición. Sin embargo, puede ser extremadamente difícil determinar qué condición causa qué dolor cuando una persona tiene ambos.
Al trabajar solo y con su médico y / o fisioterapeuta, puede determinar dónde tiene puntos gatillo y cómo tratarlos mejor sin empeorar su fibromialgia. Es probable que aliviar el dolor miofascial calme los síntomas de la fibromialgia, por lo que puede ver un doble beneficio.
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