FIBROMIALGIA

Un gran desafío del siglo XXI es el llamado síndrome de Fibromialgia.
Fibromialgia es el nombre de un padecimiento ampliamente difundido en nuestros tiempos cuyo principal síntoma es un dolor crónico generalizado. Es un desafío en el sentido que viene a mostrarnos las contradicciones de la medicina modera, nos plantea problemas sociales, económico y filosóficos. Fibromialgia, no quiere decir nada (Fibro = Fibra. Mio = Musculo. Algia = Dolor) y sin embargo lo quiere decir todo.

Aproximación a una definición:
Si bien fue reconocida por la OMS en 1992, luego de una definición con criterios diagnósticos realizada en 1990 por The American College of Rheumatology, la definición fue muy básica:

1- Dolor crónico generalizado no articular de mas de 3 meses de duración.
2- Dolor en 11 de los 18 puntos definidos.

Esto dio paso a que erróneamente en un principio se consideró una enfermedad exclusivamente del sistema musculo-esquelético, cosa que trajo rápidamente problemas de orden practico e inclusive filosóficos.
La definición original, carecía de síntomas fundamentales que conlleva este síndrome: la fatiga, trastornos del sueño, trastornos cognitivos, trastornos del ánimo, al igual que una gran falta de vitalidad para las tareas cotidianas. Por ende, una definición un poco mas certera aportada por el CDC (Centro Control y Prevención Enfermedades -USA), sería: “Trastorno de etiología desconocida que se caracteriza por dolor músculo-esquelético generalizado, trastornos del sueño, cansancio y a menudo acompañado de problemas del estado de ánimo”.
Desde entonces, se han realizado investigaciones más profundas al respecto y el rol fundamental que tiene el Sistema Nervioso en la génesis de este mal. Dicho de paso, la Terapia Neural, su eje fundamental de acción, es trabajar en la regulación del sistema nervioso autónomo. Hoy ya sabemos que existe una profunda y extensa alteración de los nociceptores que son aquellas neuronas receptoras que tienen como función en el sistema nervioso,
detectar cualquier posible amenaza o daño que se pueda producir en cualquier parte del organismo. Estos estímulos pueden ser de cualquier índole: físico, químico, psíquico, emocional, y que pueden ser potencialmente dañinos. Cuando los nociceptores se activan, se pone en marcha el mecanismo de la elaboración del dolor, como método de información. Comienza así, un mecanismo de atención y acción para evitar el daño o reparar éste, si es que se ha producido. Los Nociceptores están en todos los tejidos corporales: piel, tejido adiposo, músculos, fascias, ligamentos, tendones, huesos, vísceras…etc. Estos receptores generalmente están en reposo y se activarán ante estímulos de ALTA INTENSIDAD que son potencialmente dañinos… no es necesario que haya una herida o lesión física para que estos se exciten. Se produce ahí, una escala de transporte de esta información dolorosa hacia el cerebro. Una vez procesada esta información potencialmente dañina, se activa un sistema de alerta para generar una respuesta rápida para evitar la posible lesión. Como en cualquier respuesta al estrés, los músculos se tensan, el corazón y la respiración se aceleran, aumenta la temperatura corporal, la boca se seca y funciones básicas como digestión o sexualidad disminuyen, es decir se activa el sistema nervioso simpático. Cuando la respuesta es adecuada, el sistema nervioso libera endorfinas, endocannabinoides, serotonina, glicina y otros neurotransmisores inhibitorios que calmarán ese dolor, y así, progresivamente el sistema de alerta vuelve a su potencial de reposo.
Ahora, cuando realmente existe lesión o herida de un órgano o parte del organismo, el mecanismo de acción cambia y ya no se trata solamente de evitar el daño (que ya está hecho), si no mas bien a ayudar en el proceso de reparación. Así se activa el proceso de inflamación que permite reparar los tejidos dañados. En esta inflamación, los nociceptores se hacen mas sensibles al estimulo, es decir bajan su “umbral para el dolor” y se crea así, una zona periférica al daño mas sensible a los estímulos justamente para permitir esa reparación del tejido…. A esto se le llama “Fenómeno de SENSIBILIZACION” y esto explica por qué las regiones vecinas a una lesión son más sensibles y dolorosas ante cualquier estímulo.
Hasta ahora, se han descrito los mecanismos normales de control y regulación que tiene el organismo ante la amenaza de una lesión o directamente ante una lesión aguda. Lo interesante, es que este fenómeno de sensibilización se puede también producir en ausencia de una lesión o herida. Esto ya que, si bien el sistema de los nociceptores responde a estímulos de alta intensidad, también es capaz de reconocer estímulos de baja intensidad, pero repetidos de forma frecuente y continuas durante el tiempo. A esto se le llama “Fenómeno de SUMACION TEMPORAL”. Este fenómeno se da en nuestra vida cotidiana y pueden ser estímulos de orden mecánico, térmico, auditivo, químico, psicológico o emocional. Por ejemplo, una persona que está contínuamente sometida a presiones de orden psicológico en el trabajo o la casa, desarrollará con el tiempo el fenómeno de Sumación Temporal y su Ser estará mucho mas sensible e irritable ante estímulos menores, así, su organismo presentará un estado de híper activación preparándose para la respuesta de lucha o huida.
Como en general no sucede ninguno de esos eventos, el cuerpo acumula tensión muscular, aumento de flujo sanguíneo e híper vigilia, impidiendo que el organismo vuelva a un estado de reposo reparador.

Nociceptores y Fibromialgia:
Cuando se profundiza en la historia de vida pacientes con fibromialgia, es claro que siempre hay una historia de abuso de cualquier origen, con años de desarrollo. Son personas que vienen acumulando tensión tras tensión, sin espacios de recuperación físico ni psíquico-emocional. Los pacientes con fibromialgia, detectan bien los diferentes tipos de estímulos, pero el problema reside en que poseen un “Umbral del Dolor” disminuido, producto de la constante Sumación Temporal. Esta disminución del umbral es generalizada, afectando la piel, músculos, fascias, vísceras etc. provocando un dolor extenso y espontáneo. Además, existe un estado permanente y anormal de Sensibilización que se distingue de las personas que no padecen de fibromialgia.
Este estado de Sensibilización persistente ocasiona una activación mantenida de los sistemas de alerta, con una hiperactivación del sistema neurovegetativo simpático, que nos preparan para respuestas de huida o ataque: contractura muscular, aumento frecuencia cardíaca y respiratoria y alteraciones del sueño con híper vigilia.
El por qué se presentan estos fenómenos de Sensibilización y Sumación temporal en los pacientes con Fibromialgia, se debe a que el organismo viene desde tiempos prolongados adaptándose a situaciones de estrés continuo sin el tiempo necesario para que los mecanismos de regulación del organismo vuelvan a estados de reposo.

Mitocondrias y Fibromialgia:
En una continua investigación para un mejor entendimiento de la fibromialgia, que es como una desregulación de todos los mecanismos fisiológicos que nos permiten estar activos durante el día, han tomado particular interés las mitocondrias.
La mitocondria es un orgánulo al interior de la célula cuya labor crucial es la fabricación de energía para las funciones celulares bajo la forma de ATP (Adenosina Trifosfato) y hemos visto que uno de los síntomas principales de la fibromialgia es la falta de energía y vitalidad para hacer tareas comunes.
En estudios histológicos de biopsia de músculo esquelético de pacientes con fibromialgia, se ha visto una disminución del número de mitocondrias, lo que hace suponer que el paciente, al presentar en sus células menor cantidad de mitocondrias, tiene menos capacidad de sintetizar energía, con la fatiga que eso conlleva.

Síntomas:

1- DOLOR: Es el síntoma más frecuente en las personas con fibromialgia. Habitualmente se presenta de forma gradual. Afectando progresivamente a zonas corporales extensas. Se destacan, dolores en zonas occipitales, cervicales, escapulares, dorsales, lumbares, brazos y piernas. Este dolor suele ser continuo, generalmente en zonas vertebrales. El dolor suele aumentar con posiciones mantenidas o con carga física.
2- FATIGA: La fatiga, sensación de cansancio o desvitalización, se encuentra presente en mas del 70 % de los pacientes. Puede presentarse una crisis de agotamiento de 1 a 2 días de duración. (por esta razón, a este cuadro se lo denomina en algunos textos como Síndrome de Fatiga Crónica).
3- SINTOMAS SENSORIALES: Los pacientes con fibromialgia suelen describir sensación de hormigueo en manos y piernas, asimismo intolerancia al ruido.
4- SINTOMAS MOTORES: Existe cierto grado de rigidez matinal y a la palpación de diferentes grupos musculares se encuentran contracturas crónicas con presencia de gelosas.
5- SINTOMAS VEGETATIVOS: Existe una sensación de tumefacción de manos, sensación de mareo, sudoración y alteración de temperatura corporal.
6- SINTOMAS COGNITIVOS: Hay una disminución de la memoria reciente y dificultad a encontrar las palabras adecuadas durante la expresión verbal.
7- SINTOMAS AFECTIVOS: El dolor generalizado afecta el estado de animo, presentándo ansiedad y alteraciones como cuadros depresivos.
8- OTROS SINTOMAS: Cefalea crónica, síndrome de intestino irritable y bruxismo.

Tratamiento:

En la medicina convencional el tratamiento se enfoca en tres ejes:
1. Información al paciente
2. Tratamiento Farmacológico: uso de antidepresivos, ansiolíticos, relajantes musculares, inductores del sueño.
3. Tratamiento no farmacológico: Programa de ejercicios, terapia psicológica.

El resultado es que generalmente los pacientes se encuentran poli medicamentados, con poco alivio de la sintomatología general y a medida que pasa el tiempo, el organismo crea acostumbramiento a ciertos fármacos. El paciente que llega en general a nuestra consulta ya viene además desmotivado por la falta de respuesta que ofrecen los medicamentos clásicos. Y si bien a veces el dolor esta mitigado, la constante sigue siendo la falta de energía para las tareas cotidianas.

En nuestro centro de salud, tenemos un enfoque integral sobre la fibromialgia, entendiendo que al ser un cuadro complejo es necesario tener un enfoque multisistémico y multidisciplinario.
En nuestra consulta, como eje central empezamos con la Historia de Vida del paciente lo cual es fundamental para llegar a entender cómo, desde cuándo y por qué esa persona tuvo que hacer un cuadro de fibromialgia. Es fundamental entender este paso para desde ahí, y junto con el paciente, buscar una salida.
Ya explicamos la función principal del sistema nervioso central en esta enfermedad, y es por eso que luego de la historia de vida, seguimos con Terapia Neural.
Terapia neural es una terapia de origen alemán que permite mandarle ciertos impulsos específicos al sistema nervioso del paciente para que el sistema nervioso vuelva a puntos de equilibrio que perdió al desarrollar la enfermedad. La terapia neural, no es un tratamiento sintomatológico, es decir no esta ahí para tapar síntomas, si no para desencadenar procesos de Auto-Eco-Organización, que es la capacidad de volver a darle al organismo la auto sanación, entendiendo que, si uno tiene la clave para enfermar, también existe la clave para sanar.
Usamos medicina ortomolecular, es decir el uso de minerales, vitaminas y aminoácidos utilizados en mezclas y dosis adecuadas sobre todo para el cuadro de cansancio, de desvitalización y depresión que acompaña este síndrome. Siempre detrás de la fibromialgia, ante la cronicidad del cuadro, existe una merma en las reservas nutricionales del organismo y con la medicina ortomolecular somos capaces de aportarle al organismo los nutrientes faltantes.

La homeopatía, nos ayuda en tres pilares fundamentales:
1. Detoxificación del organismo, sobre todo del sistema Hepático, Renal y Linfático (ya que en general son pacientes poli medicamentados de años de evolución y con dietas inadecuadas).
2. Fortalecer los ejes que participan en la PNEI (Psico-Neuro-Endocrino-Inmunología).
3. Fortalecer y estimular la respiración celular (fortaleciendo la función mitocondrial) que es la responsable de fabricar energía bajo la forma de ATP para un correcto funcionamiento de la célula y por ende del organismo.
El acompañamiento psicológico se hace necesario frecuentemente ya que la Historia de Vida así lo requiere. Cuando el paciente llega a nuestra consulta, generalmente lleva años con un cuadro de Fibromialgia y hay que buscar en el mismo paciente sus mecanismos de resiliencia para aprender de su enfermedad y desde ahí desarrollar los mecanismos propios para salir de ella.

Mirada Filosófica sobre la Fibromialgia:

La Fibromialgia es un cuadro controversial y que viene a mostrarnos las limitantes de las ciencias médicas modernas, al igual que la necesidad de abrirse a una medicina mas humanista para una real comprensión y una salida para este mal del siglo XXI.
Primicia: este síndrome no puede entenderse separado de la cultura en la que ha emergido. La Fibromialgia es tan sólo una etiqueta diagnóstica que condensa el sufrimiento de varios individuos que en su mayoría son mujeres. Es un cuadro donde toda la aparatología medica es inútil, exámenes de laboratorio, biología molecular y exámenes de imágenes no muestran alteración alguna y sin embargo las instituciones de salud nacional e internacional (OMS) sí reconocen el síndrome. El desafío para la medicina moderna es traducir satisfactoriamente el paradigma reinante en esta medicina científicamente estructurada a la experiencia subjetiva que aqueja al paciente.
Resulta ser que la fibromialgia, bajo esta mirada, es una posibilidad para enriquecer el arte de sanar, que es la medicina de todos los tiempos. Es un puente de reflexión entre las ciencias y las humanidades, y en eso, la Terapia Neural que trabaja desde el sentir-pensar tiene todo que aportar, pues nacida desde la ciencia mas concreta, ha sido capaz de integrar la visión humanista de la filosofía en aras de la salud.

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    Muy buena información ojalá llegue el tratamiento al servicio público ya que los recursos con que se tratan esta enfermedad no dan niun resultado he sufrido por años la enfermedad sin mejoría nada me quita el dolor y veo una posibilidad de tener una esperanza gracias

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