Douleur et Analgésie

, 20:200 | Cite as

Synthèse des mécanismes impliqués dans un syndrome douloureux complexe : la fibromyalgie

Article De Synthèse

Résumé

La fibromyalgie est un syndrome présentant un tableau clinique complexe dans lequel s’inscrivent des douleurs diffuses, mais aussi des troubles du sommeil, de l’humeur et une panoplie de symptômes accompagnateurs, qui peuvent être présents ou absents selon les patients, dont des troubles gastriques et des problèmes de mémoire pour ne nommer que ceux-ci. Devant une telle complexité, il n’est pas étonnant que des mécanismes impliquant plusieurs systèmes aient été proposés pour tenter d’élucider ce syndrome. Dans cet article de synthèse, nous proposons de diviser en neuf grandes catégories les différents mécanismes proposés pour expliquer les douleurs diffuses dont souffrent les patients fibromyalgiques : 1) un phénomène périphérique qui pourrait impliquer les systèmes musculaires, humoraux, vasculaires, immunitaires, ou endocriniens ; 2) une sensibilisation spinale ; 3) une dysfonction des mécanismes endogènes d’inhibition causée par un déficit des contrôles inhibiteurs diffus nociceptifs ; 4) l’existence d’une facilitation centrale, par augmentation des mécanismes cérébraux pronociceptifs ; 5) une perturbation des mécanismes psychiques (émotionnels et/ou cognitifs) ; 6) une modification des activités thalamiques et limbiques ; 7) des modifications au niveau de certaines activités neurohormonales hypothalamiques et hypophysaires ; 8) une dysfonction au niveau de l’activité autonomique ; 9) et des changements au niveau de l’architecture du sommeil. Il est fort possible que la réponse réside dans plus d’un mécanisme. Il est toutefois intéressant de voir comment chacune de ces théories permet de retrouver certaines pièces du casse-tête et pourrait mener à des modèles intégrateurs pour mieux soutenir la recherche de traitements plus efficaces pour soulager les patients qui souffrent de ce syndrome de douleurs diffuses encore mal compris.

Mots clés

Mécanismes Fibromyalgie Sensibilisation périphérique centrale CIDN Contrôles endogènes 

Review of the mechanisms involved in a complex pain syndrome: fibromyalgia

Abstract

Fibromyalgia is a complex clinical syndrome involving diffuse pain as well as sleep mood and memory disorders and a wide range of symptoms that can include gastrointestinal disorders, among others, depending on the patient. In light of this complexity, it is not surprising that numerous mechanisms involving several biological systems have been proposed to explain the syndrome. In this review article, we divide these various mechanisms into nine major categories discussing: 1) a peripheral phenomenon that could involve muscular, humoral, vascular, immunological, or endocrine systems; 2) spinal sensitization; 3) dysfunction of endogenous inhibitory mechanisms due to deficient diffuse noxious inhibitory controls; 4) the existence of a central facilitation, through increased activity of nociceptive brain mechanisms; 5) disturbances in psychological mechanisms (emotional and/or cognitive); 6) changes in thalamic and limbic activities; 7) modification of certain neurohormonal activities in the hypothalamus and pituitary gland; 8) dysfunction of the autonomic nervous system; 9) and modification of sleep architecture. Certainly, more than one mechanisms is involved in this pathology and it would be beneficial to determine how each of these possibilities impact various aspects of this condition, leading to integrated models. These models would support further research of effective treatments for patients affected by this poorly understand syndrome.

Keywords

Mechanisms Fibromyalgia Peripheral and central sensitization DNIC Endogenous controls 

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© Médecine et Hygiène et Springer-Verlag France 2007

Authors and Affiliations

  1. 1.Faculté de médecine et des sciences de la santéuniversité de Sherbrooke axe douleur CRC-CHUSSherbrookeCanada

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