Fibromyalgia: new piece in the puzzle

Scientists suggest another source for the painful condition that affects nine women to each man. Learn how this can change the way you handle

Deborah Maxx / Educational Toys Holz Meister (doll)

Instead of the center, the periphery: this is the change of axis proposed by a pair of researchers regarding the physiological cause of fibromyalgia, a chronic problem that spreads pain throughout the body and affects between 2 and 3% of the Brazilian population. According to a study by rheumatologists Xavier Caro, Northridge Medical Center and Hospital, and Earl Winter, of North Central University, both in the United States, the syndrome would be more associated with changes in nerve cells than a defect in the skin. of the central nervous system that manages the perception of pain. The hypothesis breaks the paradigm established until the moment and brings possible repercussions in the treatment of the disorder.

Caro and Winter came to this conclusion after performing biopsies on the skin of the thigh and calf of 41 patients with fibromyalgia and 47 patients without the syndrome. In tissue analysis, they found that the carriers had fewer nerve fibers in the epidermis, which would be at the heart of the constant painful sensation. In addition, they noted a link between the lower nerve density there and an immune change already related to diseases that also afflict the peripheral nervous system, such as multiple sclerosis.

“These observations indicate that the current paradigm of fibromyalgia, in which central sensitization is seen as the main driver of the disorder, requires modification,” Caro and Winter argue. The finding would be a response, they said, to the fact that hundreds of their patients complain of a burning sensation, shock and body weight, evidence of a nerve anomaly. Among these people, even a hug hurts. In an interview with HEALTH, other experts on the subject say it is too early to say how much the discovery will change what is known about the disorder. But there is a certain conviction that it represents a new piece in the complex puzzle that forms this syndrome.

Today, the most accepted explanation for the origin of generalized pain is an over-sensitivity of the central nervous system. Rheumatologist Rafael Chakr, of the Hospital de Clínicas in Porto Alegre, participated in studies at the University of Indiana in the United States, which accused of brain dysfunction by means of clinical exams. In patients with fibromyalgia, the body’s natural analgesics are reduced, while substance P, associated with inflammation and anxiety, appears at elevated levels. “This imbalance would justify the wide range of manifestations, such as diffuse pain, fatigue, insomnia, memory deficits and depression,” says rheumatologist Evelin Goldenberg of the Israelita Albert Einstein Hospital in Sao Paulo.

One of the opponents of Caro and Winter’s theory, Professor Daniel Clauw of the University of Michigan, also on American soil, believes that changes in peripheral nerves would play a secondary role in the genesis of fibromyalgia. “It is hard to imagine that the loss of nerve fibers in the skin could be responsible for the severe fatigue, memory lapses and sleep disorders associated with the disorder,” criticizes the physician, who published in the respected The Journal of the American Medical Association a top review of research on the disease since 1955.

For Clauw, there is abundant evidence that the central nervous system is responsible for the disarray that leads to the syndrome, and the findings of Caro and Winter would be more a consequence than the cause of the problem. “They may even be the result of muscular deconditioning that usually occurs in these patients due to the pain and fatigue,” adds rheumatologist Eduardo Paiva, head of the Fibromyalgia Outpatient Clinic at the Hospital de Clínicas of the Federal University of Paraná.

But … and in practice ?!

Even without knowing for sure whether the loss of nerve fibers is cause or effect, the finding has the potential to tinker with the control conduits of the disorder. “We now have new information to further customize the treatment,” says Chakr. The therapeutic plan to silence the syndrome needs to be as comprehensive as its symptoms. Therefore, doctors may prescribe analgesics, antidepressants, anticonvulsants, as well as cognitive-behavioral therapy and regular physical activity. If in the future we confirm that the patient has a more peripheral disorder, it would be possible to look for (and appeal to) solutions more focused on the superficial nerves than in the central nervous system, as methods based on electrical stimulation.See too

Nowadays, despite difficult control, a good part of the people with fibromyalgia manages to obtain the functional cure, when the symptoms stop imprisoning the quality of life. But everything depends on a precise diagnosis, something that does not always happen. The American College of Rheumatology redefined, three years ago, the criteria that fit a patient as a carrier of the syndrome. The parameters today involve the presence of pain for more than three months in different areas of the body, accompanied by fatigue, sleep and memory disorders or even gastrointestinal problems. “It is important that the consultation be long and very detailed, including because psychological trauma favors the onset of fibromyalgia,” says Evelin. In fact, not a few pieces of this puzzle. Fortunately, from the scientist’s desk to the rheumato’s office,

Therapeutic workout

Regular practice of mild or moderate exercise is already part of the treatment of fibromyalgia. The most recommended modalities are low-impact aerobic activities such as swimming and walking, and stretching. According to the rheumatologist Rafael Chakr, they minimize the sensation of pain because they help to rebalance the neurochemical mismatch behind the syndrome. Not only that: keeping the body active dribbles to muscular rigidity and improves the sleep pattern. But it is no use if you exceed. Exaggerations only make things worse.

The diagnosis has changed.

Until recently, the doctor had to palpate 18 painful spots around the body to detect fibromyalgia. That fell apart. Today, the following factors are taken into account:

  • Diffuse pain in five to seven body parts for more than three months
  • Chronic fatigue
  • Memory and concentration problems
  • Insomnia and restless sleep
  • Frequent diarrhea or constipation
  • Constant urge to urinate
  • Excessive sweating
  • Sensitivity to cold

The Fibromyalgia Parts

See the physiological, psychological and environmental conditions that can culminate in the syndrome

Stress and traumas

Terms of relationships, losses, professional crashes, problems at home, childhood traumas and car accidents that affect the neck region serve as triggers for the disorder or its aggravation.

Central sensitization

People with fibromyalgia have a neurochemical alteration in the central nervous system, which increases the perception of pain. They have fewer substances that inhibit this sensation and more molecules in charge of amplifying it.

Psychic Disorders

Depression and anxiety are common in patients with the syndrome and can both trigger it and be a consequence of chronic pain and fatigue.

Less nervous fibers

According to the new American study, patients with the condition have a lower density of nerve fibers in the epidermis, which would help explain the constant pains that arise after a slight touch on the skin.

Conspiracies of the environment

The disorder can give faces after bacterial and viral infections. In addition, their carriers are more sensitive to cold, moisture, over-exertion and hormonal oscillations.

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