FIBROMIALGIA

Studi Scientifici


Riferimenti scientifici


 

Afton L. Hassett, Diane C. Radvanski, Evgeny G. Vaschillo, Bronya Vaschillo, Leonard H. Sigal, Maria Katsamanis Karavidas, Steven Buyske, Paul M. Lehrer. A Pilot Study of the Efficacy of Heart Rate Variability (HRV) Biofeedback in Patients with Fibromyalgia. March 2007, Volume 32, Issue 1, pp 1–10. Applied Psychophysiology and Biofeedback.

Arnold LM, Hudson JI, Hess EVet al. Family study of fibromyalgia. Arthritis Rheum. 2004;50(3): 944-952.

Arnold B., Häuser W., Arnold, M. Bernateck, M. Ber nardy K. Brückle W., et al. (2012). Multicomponent therapy of fibromyalgia syndrome: Systematic review, meta-analysis and guideline. Der Schmerz, 26(3), 287– 290.

Babu, A. S., Mathew, E., Danda, D., & Prakash, H. (2007). Management of patients with fibromyalgia using bio feedback: A randomized control trial. Journal of Medical Sciences, 61(8), 455–461.

Benjamin S, Morris S, McBeth J, Macfarlane GJ, Silman AJ. The association between chronic widespread pain and mental disorder: a population-based study. Arthritis Rheum 2000;43(3): 561—7

Bennett RM. Adult growth hormone deficiency in patients with fibromyalgia. Curr Rheumatol Rep 2002;4(4):306—12.

Bennett RM. Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):215-232.

Buckelew SP, Conway R, Parker J, Deuser WE, Read J, Witty TE, et al. Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res1998;11:196–209.

Busch, Sandra C Webber, Rachel S Richards, Julia Bidonde, Candice L Schachter, Laurel A Schafer, Adrienne Danyliw, Anuradha Sawant, Vanina

Dal BelloHaas, Tamara Rader, Tom J Overend - Resistance exercise training for fibromyalgia. 2013 - Cochrane Library.

Busch1, Karen A.R. Barber, Tom J Overend, Paul Michael J Peloso, Candice L Schachter. Exercise for treating fibromyalgia syndrome.17 October 2007. Cochrane Musculoskeletal Group.

Cazzola M, Sarzi Puttini P, Stisi S, Di Franco M, Bazzichi L,Carignola R, et al., Italian Fibromyalgia Network. Fibromyalgia syndrome: definition and diagnostic aspects. Reumatismo 2008;60(Suppl 1):3-14.

Cazzola M, Sarzi-Puttini P, Buskila D, Atzeni F. Pharmacological treatment of fibromyalgia. Reumatismo 2007;59(4):280—91.

Croft P, Burt J, Schollum J, Thomas E, Macfarlane G, Silman A. More pain, more tender points: is fibromyalgia just one end of a continuous spectrum? Ann Rheum Dis. 1996;55:482–485. doi: 10.1136/ard.55.7.482.

Deare JC1, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, Littlejohn G. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013 May 31;(5):CD007070. doi: 10.1002/14651858.CD007070.

Ferraccioli G, Ghirelli L, Scita F, Nolli M, Mozzani M, Fontana S, et al. EMG-biofeedback training in fibromyalgia syndrome. J Rheumatol (1987;14:820–5).

Flor H, Birbaumer N. Comparison of the efficacy of electromyographic biofeedback, cognitive- behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. Journal of Consulting and Clinical Psychology. 1993;61(4):653–658.

Furlan R, Colombo S, Perego F, Atzeni F, Diana A, Barbic F, et al. Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. J Rheumatol 2005;32(9):1787—93.

Häuser W, Urrútia G, Tort S, Üçeyler N, Walitt B. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD010292. DOI: 10.1002/14651858.CD010292.

J. A. Glombiewski, A. T. Sawyer, J. Gutermann, K. Koenig, W. Rief, and S. G. Hofmann, “Psychological treatments for fibromyalgia: a meta-analysis,” Pain, vol. 151, no. 2,pp. 280–295, 2010.

J. C. Rains, “Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache”. Headache, vol. 48, no. 5, pp. 735–736, 2008.

John H. Juhl - Fibromyalgia and the Serotonin Pathway. Alternative Medicine Review,Volume 3, Number 5 1998.

Kayiran S, Dursun E, Dursun N, Ermutlu N, Karamürsel S. Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial. Applied Psychophysiology Biofeedback. 2010;35(4):293–302.

Kravitz HM, Esty ML, Katz RS, Fawcett J. Treatment of fibromyalgia syndrome using low-intensity neurofeedback with the flexyx neurotherapy system: a randomized controlled clinical trial. Journal of Neurotherapy. 2006;10(2-3):41–58.

Large RG, Lamb AM. Electromyographic (EMG) feedback in chronic musculoskeletal pain: a controlled trial. Pain. 1983;17(2):167–177.

Licciardone JC1, Stoll ST, Cardarelli KM, Gamber RG, Swift JN Jr, Winn WB. A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty. J Am Osteopath Assoc. 2004 May;104(5):193-202.

 

Martinez Lavin, M., Hermosillo, A., Rosas, M., & Soto, M. (1998). Circadian studies of autonomic nervous balance in patients with fibromyalgia: A heart rate variability analysis. Arthritis and Rheumatism, 41, 1966–1971 

 

Moldofsky H. The significance of dysfunctions of the sleep/waking brain to the pathogenesis and treatment of fibromyalgia syndrome. Rheum Dis Clin North Am. 2009;35(2):275-283.

Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for fibromyalgia in adults. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD011824. DOI: 10.1002/14651858.CD011824.

Nelson DV, Bennett RM, Barkhuizen A, et al. Neurotherapy of fibromyalgia? Pain Medicine. 2010;11(6):912–919.

Newton-John TRO, Spence SH, Schotte D. Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain. Behaviour Research and Therapy. 1995;33(6):691–697.

Nicassio PM, Radojevic V, Weisman MH, Schuman C, Kim J, Schoenfeld-Smith K, et al. A comparison of behavioral and educational interventions for fibromyalgia. J Rheumatol 1997;24:2000–7.

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RG Gamber; JH Shores; DP Russo; C Jimenez; BR Rubin. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. The Journal of the American Osteopathic Association, June 2002, Vol. 102, 321-325.

Rizzi M, Sarzi-Puttini P, Atzeni F, Capsoni F, Andreoli A, Pecis M, et al. Cyclic alternating pattern: a newmarker of sleep alteration in patients with fibromyalgia? J Rheumatol 2004;31(6):1193—9.

Russel IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin North Am. 2009;35(2):421-435.

S. van Koulil, M. Effting, F. W. Kraaimaat, W. van Lankveld, T. van Helmond, H. Cats, P. van Riel, A. de Jong, J. F. Haverman, A. Evers. Cognitive–behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann Rheum Dis 2007;66:571-581

Sarnoch H, Adler F, Scholz OB. Relevance of muscular sentivity, muscular activity, and cognitive variables for pain reduction associated with EMG biofeedback in fibromyalgia.  Percept Mot Skills. 1997;84:1043-1050.

Sarzi-Puttini P, Atzeni F, Cazzola M. Neuroendocrine therapy of fibromyalgia syndrome: an update. Ann N Y Acad Sci 2010; 1193:91—7.

Sarzi-Puttini P, Atzeni F, Cazzola M. Neuroendocrine therapy of fibromyalgia syndrome: an update. Ann N Y Acad Sci 2010; 1193:91—7.

Sarzi-Puttini P, Atzeni F, Diana A, Doria A, Furlan R. Increased neural sympathetic activation in fibromyalgia syndrome. Ann NY Acad Sci 2006;1069:109—17.

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Sarzi-Puttini P, Buskila D, Carrabba M, Doria A, Atzeni F. Treatment strategy in fibromyalgia syndrome: where are we now? Semin Arthritis Rheum 2008;37(6):353—65.

Sarzi-Puttini P, Torta R, Marinangeli F, Biasi G, Spath M, Buskila D, et al., Italian Fibromyalgia Network. Fibromyalgia syndrome: the pharmacological treatment options. Reumatismo 2008; 60(Suppl 1):50—8.

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Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep 2002;6(4):259—66.

Thieme K, Rose U, Pinkpank T, Spies C, Turk DC, Flor H. Psychophysiological responses in patients with fibromyalgia syndrome. Journal of Psychosomatic Research. 2006;61(5):671–679.

Tort S, Urrútia G, Nishishinya MB, Walitt B. Monoamine oxidase inhibitors (MAOIs) for fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2012, Issue 4. Art.

Üçeyler N, Sommer C, Walitt B, Häuser W. Anticonvulsants for fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD010782.

van Santen M, Bolwijn P, Verstappen F, Bakker C, Hidding A, Houben H, et al. A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia.

Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Rutten-van Molken MP, Pelt RA, van Eek H, et al. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. J Rheumatol1996;23:1237–45.

W. Hauser, K. Bernardy, B. Arnold, M. Offenbacher, and M. Schiltenwolf, “Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials,” Arthritis Care & Research, vol. 61, no. 2, pp. 216–224, 2009.

Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Scand J Rheumatol1996;25:77–86

Williams DA, Cary MA, Groner KH, Chaplin W, Glazer LJ, Rodriguez AM, et al. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. J Rheumatol 2002;29:1280–6

Winfield JB. Fibromyalgia and related central sensitivity syndromes: twenty-five years of progress. Semin Arthritis Rheum 2007;36(6):335—8.

Winfried Häuser, Kati Thieme, Dennis C. Turk. Guidelines on the management of fibromyalgia syndrome – A systematic review. European Journal of Pain. Volume 14, Issue 1, January 2010. Pages 5–10.

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Wolfe F, Clauw DJ, Fitzcharles MAet al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62(5):600-610.

Wolfe F, Rasker JJ. The Symptom Intensity Scale, fibromyalgia, and the meaning of fibromyalgia-like symptoms. J Rheumatol 2006; 33: 2291–9.

Wolfe F. New American College of Rheumatology criteria for fibromyalgia: a twenty-year journey. Arthritis Care Res (Hoboken) 2010;62(5):583—4.

Yunas MB, Aldag JC. The concept of incomplete fibromyalgia syndrome: comparison of incomplete fibromyalgia syndrome with fibromyalgia syndrome by 1990 ACR classification criteria and its implications for newer criteria and clinical practice. J Clin Rheumatol. 2012;18(2):71-75.

Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum 2008;37(6):339—52.

Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Sem Arthritis Rheum. 2007;36(6):339-356.

Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 2007;36(6):339—56.


Fibromialgia, Dolore Cronico e Biofeedback

Bibliografia


 

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Quanto dura?


 Quanto dura il trattamento di Biofeedback per la Fibromialgia?


Solitamente il trattamento di Biofeedback per la Fibromialgia richiede un solo ciclo di 8-10 sedute in media. La prima seduta, durante la quale si effettua un'approfondita anamnesi e lo Stress Profile (o Profilo Psicofisiologico), ha una durata di 90-120 minuti; le sedute successive durano circa 30 minuti

Occorre un unico ciclo di sedute e, una volta completato, non occorre ripetere il trattamento.

Riguardo alla durata degli effetti del Biofeedback diversi studi ne hanno dimostrato l'efficacia a lungo termine

Come funziona?


 Come funziona il Biofeedback per la Fibromialgia?

Il Trattamento Integrato


La Fibromialgia è una sindrome complessa caratterizzata dalla presenza sia di sintomi dolorosi legati a meccanismi di sensibilizzazione delle vie del dolore, sia di sintomi non-dolorosi dovuti ad alterazioni del funzionamento del sistema nervoso autonomo.

A fronte di una tale complessità sintomatologica è necessario intervenire con un approccio integrato in grado di agire sulle cause della sintomatologia e non solo temporaneamente sui singoli sintomi. 

Per tale ragione il protocollo da noi utilizzato è di tipo integrato o multicomponenziale, prevede un unico ciclo di 10 sedute (in media) e si articola nelle seguenti modalità d'intervento, in combinazione variabile a seconda della sintomatologia del paziente:

1 – Profilo Psicofisiologico (o Stress Profile) e anamnesi completa - Nella prima seduta si effettua una valutazione approfondita delle condizioni del paziente in relazione alla specifica combinazione di sintomi fibromialgici che presenta; subito dopo, utilizzando la strumentazione del biofeedback, si effettua la misurazione (stress profile) di diverse variabili fisiologiche in condizioni di relax e di stress (lieve) per individuare le alterazioni fisiologiche su cui lavorare e per definire i protocolli più efficaci.

2 – EMG Biofeedback - Utilizzato per favorire il processo di desensibilizzazione delle vie del dolore; lo stato di iper-sensibilizzazione delle vie dolorifiche che innervano le regioni corporee doloranti fa si che anche una lieve e inconsapevole contrazione muscolare sia in grado di attivare le vie dolorifiche e quindi di indurre dolore, alimentando così indefinitamente la sensibilizzazione e quindi i sintomi dolorosi, in un circolo vizioso perpetuo:

 sensibilizzazione-->dolore-->contrazione muscolare-->dolore-->sensibilizzazione

L'EMG-Biofeedback è in grado di spezzare questo circolo vizioso al livello della "contrazione mucolare" impedendo quest'ultima all'origine. Grazie al feedback immediato fornito dalla strumentazione (elettromiogramma di superficie) l'individuo impara a riconoscere anche i livelli minimi di contrazione dei muscoli coinvolti nel dolore fibromialgico e a ridurre la frequenza di contrazioni involontarie entro valori sufficientemente bassi da consentire, finalmente, l'attivazione dei naturali meccanismi neuroplastici di desensibilizzazione dolorifica.

3 - Biofeedback Autonomico - Si tratta di un insieme di protocolli utilizzati nei casi in cui al dolore fibromialgico si accompagnino sintomi con un'importante componente disfuzionale del sistema nervoso autonomo (e centrale), come la stanchezza, l'insonnia, l'ansia, la depressione, la febbre, la nausea, ecc. L'obiettivo di questi protocolli è quello di ripristinare il normale funzionamento delle componenti autonomiche alterate.

4 – Rilassamento Progressivo da fare a casa/lavoro con CD (8 fasi) - Diversi studi hanno dimostrato che l'aggiunta di questa tecnica al Biofeedback velocizza e potenzia gli effetti di quest'ultimo.

5 - Colloqui di sostegno, psicoeducativi e preventivi finalizzati a:  

  • conoscere i meccanismi psicologicifisiologici e ambientali che sono all'origine sia della tensione muscolare involontaria che alimenta indefinitamente la sensibilizzazione dolorifica, sia delle alterazioni autonomiche alla base dei molteplici sintomi non dolorosi che nella fibromialgia quasi sempre accompagnano i sintomi dolorosi.
  • aumentare la consapevolezza dell'individuo e il suo senso di autoefficacia, ossia la consapevolezza che le alterazioni fisiologiche involontarie che causano la fibromialgia possono essere volontariamente controllate e normalizzate con le strategie apprese. 
  • imparare a controllare la risposta psicofisica agli agenti stressanti con adeguate tecniche e cambiamenti mirati nello stile di vita.

6 - Igiene del sonno: vengono fornite le indicazioni necessarie a ripristinare una sufficiente qualità del sonno. Migliorare la qualità del sonno significa agire direttamente su un insieme di potenti meccanismi psicofisiologici che contrastano fortemente gli effetti dannosi dello stress, dell'ansia, della rabbia (e di altri stati di tensione/attivazione eccessiva) sul corpo e sulla mente, aumentando la resistenza psicofisica agli stressors inevitabili.

7 - Monitoraggio attivo inter-sessione: le strategie apprese durante il trattamento integrato di biofeedback devono essere poi estese alla vita reale, al di fuori setting protetto e controllato dello studio di biofeedback; per tale ragione abbiamo implementato un sistema di monitoraggio continuo sempre attivo che, tra una seduta (o sessione) e quella successiva, accompagna e assiste la persona nel delicato processo di estensione delle abilità apprese alla vita di tutti i giorni, tramite l'uso di strumenti (cartcei, fogli elettronici e applicazioni per smartphone/tablet/computer) opportunamente tarati sulle necessità di ogni singolo individuo.

8 - Monitoraggio post-trattamento: terminate le sessioni di trattamento, le abilità apprese e già ben trasposte nella vita di tutti i giorni dovranno essere utilizzate anche nei mesi successivi; per tale ragione nei 6 mesi successivi alla fine del trattamento effettuiamo un monitoraggio volto sia a verificare i progressi attesi, sia a correggere eventuali errori d'applicazione e d'integrazione delle strategie apprese, sempre tramite l'uso di strumenti simili a quelli usati nel monitoraggio inter-sessione.

Quanto costa?


Quanto costa il trattamento di Biofeedback per la Fibromialgia?


Solitamente l'intero trattamento ha un costo contenuto consistendo in un unico ciclo di 8-10 sedute in media, senza la necessità di ricorrere a cicli successivi o periodici.

Il costo di una seduta di biofeedback o neurofeedback pari ad euro 70.00.

La prima seduta di valutazione e misurazione psicofisiologica comporta un'approfondita analisi del problema e la valutazione psicofisiologica o stress profile (con la nostra strumentazione), ha un costo di euro 120,00 e ha una durata di circa 90-120 minuti.

Lo stress profile è necessario ad individuare il locus dell'alterazione fisiologica e a stabilire il protocollo di biofeedback adeguato alla specifica situazione.

Il Biofeedback è una prestazione sanitaria detraibile.

Cause della Fibromialgia


Cause e meccanismi della Fibromialgia


La fibromialgia è una sindrome, ossia un insieme di sintomi vari e apparentemente slegati tra loro che invece sono sottesi da cause e meccanismi comuni.

Per comprendere la fibromialgia, e quindi il modo più efficace per affrontarla, è indispensabile innanzi tutto distinguere tra cause e meccanismi.

Possiamo definire cause tutti i fattori in grado di attivare i meccanismi o processi neurofisiologici e psicofisiologici che determinano i sintomi della sindrome fibromialgica.

 

Le cause principali dei sintomi fibromialgici, ossia i fattori in grado di attivare/innescare i meccanismi che producono i sintomi, sono suddivisibili in due categorie:

 

 

1 - Fattori Geneticinon necessariamente di tipo ereditario. Predispongono l'individuo a sviluppare i sintomi della fibromialgia in presenza dei fattori ambientali sotto descritti.

2 - Fattori Ambientali - legati tanto alle esperienze del passato quanto a quelle del nostro presente; rientrano in questa categoria tutti gli eventi/stimoli stressanti (stressor) o percepiti tali, inclusi gli stress lavorativi, affettivi, relazionali, cognitivi e fisici (sforzi eccessivi, malattie, infezioni, infiammazioni e traumi).

I meccanismi che producono i sintomi fibromialgici dipendono dal tipo di sintomo preso in considerazione e, come vedremo, interagiscono tra loro:

 

  • I Sintomi dolorosi (dolori diffusi, cefalea, dolori addominali, colon irritabile, ecc.) sono dovuti ai meccanismi della sensibilizzazione (periferica e/o centrale) delle vie nervose del dolore che producono un progressivo abbassamento della soglia del dolore;
  • I Sintomi autonomici (stanchezza, insonnia, ansia, depressione, febbre, nausea, ecc.) strettamente legati ad alterazioni dei meccanismi che governano il Sistema Nervoso Autonomo (e Centrale);

Le cause e i meccanismi alla base dei sintomi che caratterizzano la fibromialgia sono sintetizzati nella seguente tabella:

 

In sintesi diversi stressor (fattori stressanti) sono in grado di agire su sistemi neurofisiologici geneticamente predisposti a reagire ad essi in un modo specifico; nei pazienti fibromialgici questa predisposizione genetica si manifesta nella forma di un grado di attivazione e di reattività psicofisiologica agli stimoli particolarmente elevata ed anche di una maggiore suscettibilità delle vie nervose del dolore che innervano specifiche regioni corporee (vie di somatizzazione) a sviluppare sensibilizzazione centrale e/o periferica un meccanismo che porta l'individuo a percepire dolore anche in assenza di uno stimolo in grado normalmente di produrre dolore.


Sintomi Dolorosi e Predisposizione Genetica


Tutta la sintomatologia dolorosa è oggi attribuita ad una predisposizione genetica che favorisce l'attivazione dei meccanismi di sensibilizzazione centrale delle vie del dolore che innervano le regioni del corpo doloranti.

In parole semplici, per quanto concerne il dolore, questa predisposizione genetica si traduce in una maggiore suscettibilità delle vie nervose che trasmettono i segnali del dolore ad abbassare la loro soglia d'eccitazione (vengono attivate più facilmente) in presenza di un iniziale stimolo doloroso sufficientemente protratto, un fattore d'innesco che può essere rappresentato da stimoli sufficientemente prolungati da attivare questo processo, come la contrazione blanda, ma continua e inconsapevole dei muscoli che poi diverranno doloranti.


Le Fasi del Dolore


Chi soffre di fibromialgia percepisce dolori anche molto intensi in diverse regioni corporee senza che vi sia uno stimolo, un processo infiammatorio locale in atto o una lesione che giustifichino tale sensazione.

Com'è possibile percepire dolore senza che vi sia una lesione, un trauma, un'infiammazione, un'infezione o uno stimolo dolorifico qualunque a carico della regione corporea dolorante?

La risposta a questa domanda risiede nella patogenesi e nei meccanismi che causano il dolore in questa sindrome.

Possiamo suddividere in 3 fasi il processo che, negli individui geneticamente predisposti, porta al dolore cronico della fibromialgia e di tutte le patologie del dolore da sensibilizzazione centrale e periferica:

1 - Fase d'innesco = è la fase in cui uno stimolo sufficientemente protratto è in grado di attivare le vie dolorifiche che innervano una determinata regione muscolare del corpo e quindi di produrre la sensazione di dolore; sono fattori d'innesco comuni gli stati infiammatori causati dalla contrazione anche leggera ma prolungata e inconsapevole dei muscoli, quelli causati da infezioni e le lesioni da traumi.

2 - Fase della sensibilizzazione = è la fase in cui lo stimolo doloroso eccessivamente protratto nel tempo o ripetuto con eccessiva frequenza in un arco temporale sufficientemente lungo, abbassa progressivamente la soglia d'eccitazione delle vie nervose del dolore che innervano la regione dolente, divenendo sempre più facilmente attivabili;

3 - Fase della cronicizzazione = è la fase in cui il processo di sensibilizzazione delle vie nervose del dolore che innervano la regione dolorante ha raggiunto livelli tali da produrre le condizioni di iperalgesia e allodinia;

 


Quando il dolore diventa cronico: il circolo vizioso


 

Il lento processo che conduce allo sviluppo del dolore cronico è legato ad un circolo vizioso che viene ad instaurarsi proprio a causa dell'iniziale sensibilizzazione delle vie del dolore; per cui un evento d'innesco (contrazione prolungata e involontaria dei muscoli, infiammazioni, traumi, ecc.) provoca negli individui predisposti un aumento della sensibilizzazione delle vie del dolore che innervano la regione corporea interessata; ad una maggiore sensibilità di queste vie dolorifiche corrisponde una loro maggiore facilità e frequenza d'attivazione (bastano stimoli via via meno intensi) che determina un ulteriore aumento della sensibilizzazione, e così via.

Quindi, a partire da un certo livello di sensibilizzazione, anche stimoli totalmente innocui (in condizioni normali) diventano in grado di suscitare una sensazione di dolore sproporzionata.

A prescindere dal fattore d'innesco del processo di sensibilizzazione delle vie del dolore, quest'ultimo determina negli individui con fibromialgia le condizioni di iperalgesia(gli stimoli dolorosi producono più dolore del normale) e allodinia(gli stimoli innocui, come la leggera pressione del dito sulla zona dolorante sensibilizzata, determina dolore intenso), tipiche della fase di cronicizzazione della sindrome fibromialgica.

Questa particolare condizione di sensibilizzazione dolorifica quindi fa si che anche le lievi tensioni muscolari inconsapevoli (la fibro-mialgia colpisce muscoli e legamenti) sono in grado di stimolare intensamente le vie del dolore sensibilizzate determinando così la percezione del dolore anche quando la zona dolorante non è apparentemente sottoposta a stress fisici in grado di produrre dolore.


Le cause dei sintomi autonomici 


Anche tutti gli altri sintomi della fibromialgia (es. stanchezza, ansia, cefalea, colon irritabile, ecc.) possono esser causati o esacerbati da alterazioni funzionali del Sistema Nervoso Centrale e Autonomo che sono quasi sempre legate a stati d'ansiastress acuto/cronico e/o depressione, che sono a loro volta in parte espressione di una predisposizione genetica e che sono in grado di potenziare/alimentare/amplificare il processo di sensibilizzazione centrale delle vie del dolore.

 


Una terapia efficace deve agire sulle cause


Il trattamento di qualsiasi patologia sarà tanto più efficace quanto più esso è in grado di incidere sulle cause del disturbo e non solo sulla sintomatologia.

Tuttavia l'impossibilità di individuare una causa organica (lesione, infiammazione, ecc.) rende la fibromialgia una condizione particolarmente difficile da trattare con i farmaci oggi a disposizione (tutti, senza eccezioni, scarsamente efficaci) specie se questo disturbo viene considerato da una prospettiva che tiene conto solo degli aspetti classicamente "organici".

La fibromialgia è invece una sindrome caratterizzata da un'evidente componente psicosomatica

Come abbiamo visto il fatto che la fibromialgia sia una "sindrome", ossia un insieme di sintomi e segni molto vari e apparentemente slegati tra loro, non significa che questi ultimi non siano sottesi da cause comuni, nel caso specifico: (1) - la sensibilizzazione delle vie del dolore; (2) - le alterazioni del sistema nervoso autonomo e centrale.

Ne consegue che un trattamento efficace deve:

1 - favorire il processo di desensibilizzazione delle vie del dolore (iper-sensibilizzate), riducendo progressivamente l'iperalgesia e l'allodinia, e quindi il dolore;

2 - ridurre i livelli di iper-attivazione e iper-reattività psicofisiologica che alimenta sia tutta la sintomatologia che si accompagna ai dolori diffusi, sia il processo di sensibilizzazione delle vie del dolore.

Il trattamento di Biofeedback integrato da noi utilizzato è composto da protocolli specifici in grado di agire efficacemente su ciascuno di questi fattori, facilitando da un lato il processo di de-sensibilizzazione delle vie del dolore e, dall'altro, normalizzando i livelli di attivazione del sistema nervoso autonomo e centrale che alimentano i sintomi fibromialgici.