Acceso usuarios
María Pilar Acín Lázaro, R. Escartín
Objetivos: La fibromialgia es una de las causas más comunes de dolor musculoesquelético crónico localizado o generalizado, que se caracteriza por la presencia de puntos anatómicos dolorosos, rigidez matutina, fatiga fácil, trastornos del sueño y otros síntomas asociados. Algunos autores lo relacionan con un procesamiento anormal del dolor a nivel central, considerando la fibromialgia como un dolor con componente neuropático. También se ha demostrado déficit en la secreción de serotonina y otras sustancias relacionadas con la regulación de los procesos dolorosos. En este trabajo valoramos la eficacia de gabapentina en pacientes diagnosticados de fibromialgia. Material y método: Estudiamos 24 pacientes, todas mujeres, edad media 42,54 ± 13,08 (33-60). El 50% (12) presentan cervicalgia y 50% (12) cervicalgia y lumbalgia como síntomas dolorosos principales. Estaban siendo tratadas con AINE 15 pacientes, tramadol 12, fentanilo TTS 2, ansiolíticos 9, antidepresivos 9, buprenorfina TDS 1, fisioterapia 14, inyección en puntos gatillo con anestésico local 13, iontoforesis 1. Estos tratamientos les habían proporcionado alguna mejoría, por lo que sin modificarlos se prescribe gabapentina como monoterapia anticonvulsivante. La intensidad del dolor se valora según EVA, test de Lattinen, actividad física y descanso nocturno, antes del inicio y a los 9 meses de tratamiento con gabapentina. Registramos dosis diaria inicial y final, valoración analgésica pre y postratamiento y efectos secundarios durante este periodo. Se realiza estudio estadístico descriptivo con el programa Statview SE Graphics. Resultados: Los resultados se basan en la valoración de EVA: EVA media inicial 5,2 ± 1,5 (R 3-8) y EVA media final 3,2 ± 1,3 (R 2-7). Ocho pacientes (33,33%) relatan una mejora en actividad física y 10 (41,6%) en la calidad del sueño. El 37,5% (9) de las pacientes obtiene un control del dolor bueno, el 41,6% (10) regular, el 16,6% (4) malo y el 4,16% (1) se suspende el tratamiento por efectos secundarios. La dosis diaria media inicial de gabapentina es de 300 mg.día-1 y la final 762,5 ± 409,46 mg.día-1. El tiempo medio de tratamiento es de 9,04 ± 6,7 meses. Los efectos secundarios aparecen en 9 pacientes (37,5%), que presentan mareo 6 (25%), inestabilidad 2 (8,33%) y 1 hay que suspenderlo por excesiva somnolencia. En el momento de finalizar el estudio siguen en tratamiento 23 pacientes, 4 de ellas, con dosis bajas (300 mg/día) por manifestar efectos secundarios. Conclusiones: Frecuentemente, los pacientes de fibromialgia son tratados con diferentes terapias y con resultados modestos, y aunque en nuestra serie hay casos con un control analgésico bueno a baja dosificación, serán necesarios nuevos estudios comparativos que nos aporten más datos para valorar mejor dichos resultados.
Objectives: Fibromyalgia is one of the most common causes of local or widespread chronic musculoskeletal pain that is characterized by the presence of painful anatomical points, morning rigidity, easy fatigue, sleep disorders and other related symptoms. Some authors claim that fibromyalgia is due to an abnormal processing of pain at the central nervous system and has a neuropathic component. A deficit in the release of serotonin and other substances involved in the regulation of nociceptive processes has also been shown. In this study we determined the effectiveness of gabapentin in patients diagnosed of fibromyalgia. Material and method: We studied 24 patients, all of them women with a mean age of 42.54 ± 13.08 (33-60). Fifty per cent (12) had cervical pain and 50% (12), cervical and lumbar pain as the main painful symptoms. Fifteen patients were being treated with NSAIDs, 12 with tramadol, 2 with fentanyl TTS, 9 with sedatives, 9 with antidepressants, 1 with buprenorphin TDS, 14 with physiotherapy, 13 with injection of local anesthetic at the trigger points and 1 with iontophoresis. These therapies had somewhat improved their condition, so they were maintained unchanged and gabapentin was added as anticonvulsant monotherapy. Pain severity was assessed through VAS, Lattinen´s test, physical activity and night rest, before the start and after 9 months of treatment with gabapentin. Initial and final daily doses, analgesic assessment before and after treatment and side effects during this period were recorded. A descriptive statistical study was conducted using the Statview SE Graphics software. Results: Results are based on VAS scores: the initial mean VAS score was 5.2 ± 1.5 (R 3-8) and the final mean VAS score was 3.2 ± 1.3 (R 2-7). Eight patients (33.33%) reported improved physical activity and 10 (41.6%), improved quality of sleep. Pain relief was satisfactory in 37.5% (9) of patients, moderate in 41.6% (10) and poor in 16.6% (4). Treatment had to be discontinued due to side effects in 4.16% (1). Initial daily mean dose of gabapentin was 300 mg.day-1 and final daily mean dose, 762.5 ± 409.46 mg.day-1. The average length of treatment was 9.04 ± 6.7 months. Side effects appeared in 9 patients (37.5%), with dizziness in 6 (25%), lack of stability in 2 (8.33%) and discontinuation of treatment due to excessive somnolence in 1. At the end of the study, 23 patients were still being treated, 4 of them with low doses (300 mg/day) due to side effects. Conclusions: Patients with fibromyalgia are frequently managed with different therapies and poor results. Although our series included cases in which satisfactory analgesic control was achieved with low doses, further comparative studies are required in order to obtain additional data to better assess these results.
