Fibromialgia Sociedad Medica - SAVALnet€¦ · • Trastornos del sueño pueden aumentar el dolor...

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Dolor fibromialgia

Variables psicológicas

Variables biológicas

Variables socioeconómicas

Modelo biopsicosocial de fibromialgia


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El neurólogo observa dolor de cabeza crónico, el gastroenterólogo observa síndrome del intestino irritable, el otorrinolaringólogo observa síndrome de articulación temporomandibular, el cardiólogo observa costocondritis, el reumatólogo observa fibromialgia y el ginecólogo observa síndrome premenstrual.

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A7V",27#457#%•  Hipersensibilidad nerviosa, una pérdida de la habilidad para interrumpir la emisión de las señales y regularlas.

•  Dolor neuropático: origen central y no periférico. Razón por la cual la mayor parte de tratamientos dedicados a las zonas dolorosas, no son efectivos en el medio y largo plazo.

•  Trastornos del sueño pueden aumentar el dolor crónico, por lo tanto, el estudio de la calidad del sueño es un pilar importante en el diagnóstico y enfoque terapéutico de estos enfermos.

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A7V",27#457#%GHHM%Criterios clínicos para diagnostico de FM Siempre presentes Frecuentes Antec. dolor crónico difuso rigidez matinal Puntos hipersensibles fatiga Laboratorio/imágenes “N “ trastornos del sueño

depresión ansiedad cefalea parestesias Raynuad


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Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of

Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33:160-172.

La primavera. Sandro Botticelli (1477-1484)

Puntos Dolorosos de fibromialgia


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•  Criterios antiguos se basaban, esencialmente en la exploración de los puntos sensibles y la afirmación del enfermo de sufrir dolor generalizado. •  Los criterios actuales no requieren, el contaje de los puntos sensibles, contemplan aspectos sintomáticos y utilizan unas escalas para concretar el diagnóstico y determinar la gravedad de los síntomas. •  La FM así definida, se encontraría en dos franjas (WPI ! 7 y una SS ! 5) (WPI entre 3 y 6 y una SS ! 9). No olvidemos que la valoración corresponde siempre al reumatólogo, y que todos los síntomas se evalúan sólo si han estado presentes durante la última semana, incluso si está tomando medicación.


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Valor WPI en FM ( 0 – 19)

WPI = Extensión del dolor

SS Score parte I en FM ( 0 – 9)

SSS = severidad de los síntomas


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SS Score parte II en FM ( 0 – 3)

SS parte I y SS parte II = Sumatoria entre 0-12 puntos

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TABLA 1: Eficacia de tratamientos disponibles para Fibromialgia. Adaptado de J Rheum 1999; 26:408-12

SÍNTOMAS DE FIBROMIALGIA

DROGA DOLOR SUEÑO FATIGA ANIMO Antidepresivos triciclicos + + + - Antidepresivos recaptadores serotonina

± ± ± +

Inhibidores monoamino oxidasa ± ± ± ±

AINES - - - - Sedantes/hipnóticos - + - - Relajantes musculares + + ± - Opiodes + - - - Antagonistas N-methylaspartato + - - - antiepilépticos + + + -


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Fibromialgia Sociedad Medica - SAVALnet€¦ · • Trastornos del sueño pueden aumentar el dolor...

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