Dr. Martinez Lavin; “The research is neurologist fibromyalgia, but treatment remains Rheumatologist”

THE DOCTOR. Manuel Martínez Lavín and his colleagues at the National Institute of Cardiology of Mexico seem to have found the key, after the investigations have been carried out for ten years: an alteration in the functioning of the autonomic nervous system may explain the origin of fibromyalgia.

Dr. Martinez Lavin;  "The research is neurologist fibromyalgia, but treatment remains Rheumatologist"

THE DOCTOR. Manuel Martínez Lavín and his colleagues at the National Institute of Cardiology of Mexico seem to have found the key, after the investigations have been carried out for ten years: an alteration in the functioning of the autonomic nervous system may explain the origin of fibromyalgia. According to this theory patients suffer constant excess adrenaline and manifestation of widespread pain, “neuropathic pain maintained by the sympathetic system” is due to malfunction of the autonomic nervous system.

” Must end with the discussion of whether fibromyalgia is a physical or mental condition: it is a real condition, period”

Dr. Manuel Martínez Lavín, is one of the world ‘s leading authorities on fibromyalgia. He studied medicine in Mexico, he studied internal medicine at the University of St. Louis and the specialty of rheumatology at the University of La  J oya (United States). It was at the latter university where he became interested in fibromyalgia, Dr. Hench thanks, with whom he collaborated and who proposed the term fibromyalgia for this disease. On his return to Mexico he continued with investigations and made him think that the autonomic dysregulation could be the key to the mechanisms that lead to fibromyalgia.

Fibromyalgia is a common disorder that affects about 2% of the general population; most of those affected are women. It is characterized by the presence of severe chronic widespread pain, fatigue that does not improve with rest, insomnia and others with shots, such as tingling in the extremities, abdominal discomfort, frequent urination, anxiety and depression among others. “There was no logical explanation for the presence of such heterogeneous symptoms in the same person for so patients underdiagnosed and undertreated have been frequently”. ” It is clear that the human being is both mind and body and can not be separated. All chronic diseases have a physical and mental component, much more those in which pain is a major factor. From now onit will end the discussion of whether a physical or mental condition, to conclude that it is a real condition, period “ . Says Dr. Martinez Lavin, the symptoms are real and there is strong evidence. “Pain is always a subjective and private feel, but the pain neurotransmitters are too high of cerebrospinal fluid in these patients” .

HOMEWORK AND rheumatologist Neurologist

Can you stop being a rheumatic disease?

I am thinking that it is a neurological disease. However, the rheumatologist will still see the clinic because patients feel pain in muscles and joints, symptoms that can be confused with other diseases such as arthritis.

Are there factors that worsen the prognosis?

When there is a psycho- logical impact important criteria catastrophe to illness, inability to respond to it, an attitude of desperation, the prognosis is worse, but when the patient takes and fight against the disease, either fibromyalgia or other condition, it gets along better. And although we are far from effective treatment, we already have some measures that can improve the quality of life. Efforts should be directed, according to this specialist, to balance the overactivity of the autonomic nervous system through a comprehensive approach based on the understanding of the disorder, exercises that reduce sympathetic tone (here the Eastern techniques of Tai Chi and the like are useful) relaxation and psychological disciplines free diet adrenaline-like substances.

” Unfortunately  He points Dr. Manuel Martinez Lavín-  once consolidated abnormal interconnections between the sympathetic system and pain pathways, these are irreversible. In these cases you need to use antineuropáticos drugs to reduce pain.They are in research and development antineuropáticos various compounds that are likely to have application in cases of fibromyalgia “ .

At present the team of Dr. Martinez Lavin has opened new avenues of research:  “We are focused on seeing the genetic alterations that lead to this autonomic dysregulation and we are seeing the gene for the enzyme that degrades adrenaline. Alterations in this gene are present in patients with fibromyalgia. But we are still preliminary data.We will have to wait “ .

COLLABORATION Spanish-Mexican

This year has started an institutional collaboration between Spanish and Mexican scientific societies of rheumatology, which has resulted in the publication of the scientific journal “Clinical Rheumatology”, which aims to be “leading scientific expression of Spanish-speaking” as it has said the president of the SER, and future joint projects continuing education among its members. “In Mexico we see with great respect and a healthy envy the big evolution of science, medicine and specifically the Spanish rheumatology. The agreement of these two companies will bring in the future a better understanding of rheumatic diseases. But to do all these good intentions should not remain on paper, we must work so that there is an exchange of doctors, attending the respective conferences, participate in joint research projects and help in areas that stand out in both countries for all let ‘s get out benefit “ .

What diseases will be the main beneficiaries?

-those whose mechanisms we know better, such as arthritis, spondyloarthritis. The best know them allows us to offer more effective as happens now with anti-TNF treatments.

Dr. Martinez Lavin highlights coverage Spanish National Health System. “Access to drugs in Mexico is not universal, it does not reach 50% of the population; There is a non – working population that is not covered by social security and have no access to new drugs. It is a deficiency of health that we still pending and should be changed “ .

” We must work so that there is an exchange of doctors, respective conferences, joint research projects and help in areas that stand out in both countries so that we all benefit” .

A malfunction of the autonomic nervous system, possible explanation.

The autonomic nervous system is an intricate nerve network. It is the main control system of all animals, including humans. It is responsible for maintaining the functional balance of our body without us realize it (hence the term “autonomous”). It maintains blood pressure, pulse rate and respiration and normal operation of the internal organs. This system has a “sympathetic” branch called working through the production of adrenaline and accelerates the body’s functions. Counterpart is the influence of the “parasympathetic” branch that acts as an antagonist and promotes sleep and digestion. The autonomic nervous system is the interface between the mind and body. Through this system the emotions like anger or fear translate into biological functions, pallor,

Until recent years the functioning of the autonomic nervous system was virtually unknown, but the situation has changed dramatically with new technology and support of information technology, which allows the “analysis of heart rate variability.” Using this technology researchers at the National Institute of Cardiology of Mexico found that patients with fibromyalgia had a relentless hyperactivity of the sympathetic nervous system abnormality that was especially evident during the hours of sleep. In other words, patients suffering from constant excess adrenaline.

Additional research Martinez Lavin et al suggest that all the manifestations of fibromyalgia can be explained by dysfunction of the autonomic nervous system and the cardinal generalizado- The pain discomfort could be explained by the mechanism called “neuropathic pain maintained by the sympathetic system” .

THE NERVE PAIN

Usually the sensation of pain is damage in the body. However there is a different type of pain called “neuropathic” which is produced by an intrinsic alteration in pain nerves transmitters which are incessantly transmitted irritated and pain as if the body were beaten. This type of pain is accompanied by other unpleasant sensations such as burning, tingling or electric shocks. “In neuropathic pain hypersensitivity to touch there is also the contacts that are normally innocuous, such as a hug or wearing tight clothes are perceived as painful” .

Research group of the National Institute of Cardiology of Mexico show that all these neuropathic characteristics are present in patients with fibromyalgia.

Adrenaline is usually no pain generator; However, in certain types of neuropathic pain it is substance can irritate the nerve endings. This phenomenon, called “sympathetically maintained pain system” occurs, according to these studies, in patients with fibromialgy.

The theory that fibromyalgia is caused by a malfunction of the autonomic nervous system and its main symptom, pain is neuropathic and maintained by sympathetic overactivity opens new avenues to treatment. “The future for patients with fibromyalgia is more encouraging, is moving from an era of misunderstanding and disqualification, another research and recognition. This transition will result necessary improvement in treatments. If it is understood that the main control system of the body that is affected, will be the need for comprehensive treatment is taking care of both the physical symptoms, such as emotional and social impact “ .

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