Fibromiyalji Sendromu ve Nöropatik Ağrı

Abstract

Fibromiyalji sendromu yaygın vücut ağrısı ve belirli anatomik bölgelerde hassas noktaların varlığı ile karakterize, etiyoloji net olarak bilinmeyen, iş gücü kaybı ve yaşam kalitesinde bozulmaya yol açan kronik bir kas-iskelet sistemi hastalığıdır. Fibromiyalji sendromunda en sık görülen ve karakteristik semptomlar yaygın ağrı, sabah katılığı, yorgun uyanma ve uyku bozukluğudur. Aile öyküsü olanlarda fibromiyaljinin daha fazla görülmesi genetik faktörlerin rol aldığını düşündürmektedir. Fibromiyaljili hastaların ağrılı uyaranlara daha duyarlı olduğu gösterilmiştir. Fibromiyalji sendromunun etiyopatogenezi üzerine uzun yıllardır birçok çalışma yapılmakta olup multifaktöryel mekanizmalar olduğu görüşü ağırlık kazanmaktadır. Bu faktörler genetik nedenler, immunolojik mekanizmalar ve santral ve periferik teoriler olarak alt başlıklarda toplanmaktadır. Fibromiyaljinin sıklıkla santral sensitivite sendromları ile beraber olması, glutamat ve P maddesi gibi ağrı nörotransmitterlerinin artmış olması, noradrenalin, serotonin ve dopamin gibi antinosiseptif nörotransmitter düzeylerinin azalmış olması, ektopik deşarjlar/periefrik sensitizasyon/ Aβ liflerinin reorganizasyonu ve hiperaljezi ve allodinin varlığı fibromiyaljinin nöropatik ağrı sendromun bir parçası olabileceğini düşündürmektedir. Son yıllarda yapılan çalışmalar santral mekanizmaların etkinliğini desteklemektedir Nöropatik ağrı ve fibromiyalji sendromu ilişkisi literatürde yapılan az sayıda çalışmada gösterilmiştir. Son yıllardaki çalışmalarda fibromiyalji sendromu ile küçük lif polinöropatisi sıklığının saptanması ile periferik sisteminde olaya katkı sağladığı görüşü gündeme gelmiştir Bu yazıda fibromiyalji sendromu ve nöropatik ağrı son gelişmeler ışığında tekrar gözden geçirilecektir. 

Keywords

• Fibromiyalji,nöropatik ağrı,santral sensitizasyon

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