Fisiopatologia da fibromialgia

Abstract

Fibromyalgia is characterized by chronic widespread pain and the presence of tender points on palpation of specific regions of body surface. There is some agreement in various studies on its concentration during the fifth decade of life, association with female gender, as well as socioeconomic factors like low educational levels, low income and being divorced. Hypothesis of anatomopathologic disorders as fisiopathologic explanations of this syndrome have been discarded, since the morphologic alterations were attributed to sedentary lifestyle. At the moment, the most accepted mechanisms for is fisiopathologic understanding include the misbalance between pain perception and modulation mechanisms of afferent pathways. Elevated levels of substance P in the liquor and reduced concentrations of serotonin and its precursors are evidence in this direction, once substance P is a mediator of pain pathways while serotonin mediates its inhibition. Another justification to the reduced activity of serotonin is the polimorphism of cell receptors to this substance, what may also explain the familial grouping of these patients. Cerebral alterations, rostral to the thalamus, could also be responsible for the elevated perception of environmental stimuli, and the perversion of proprioception, pressure and thermal information into pain. Finally, reductionism is not an explanation for fibromyalgia, and multiple explanations have been proposed and accepted, without the exclusion of each other, including psychosocial factor, which have not been explored in this text.