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Fibromyalgie : où en est-on en 2015 ?

Fibromyalgia: Where are we in 2015?

  • Article de Synthèse / Review Article
  • Published:
Douleur et Analgésie

Résumé

La fibromyalgie fait beaucoup parler d’elle et suscite encore débats et controverses en 2015. Pourtant, il n’est plus question de remettre en cause ce syndrome facilement reconnaissable (même si le diagnostic est aussi posé avec excès). Le modèle biopsychosocial permet de comprendre et de prendre en charge de façon plus globale toutes les maladies chroniques et évite la mise en échec des patients et des soignants. La fibromyalgie est un syndrome fréquent qui touche surtout les femmes qui rapportent des douleurs chroniques, diffuses, musculaires, tendineuses et/ou articulaires. Ces douleurs sont associées à des céphalées de tension, des troubles fonctionnels intestinaux, des symptômes génitourinaires, des acouphènes, des douleurs de l’articulation temporomandibulaire, des paresthésies distales... On parle de troubles somatoformes, définis par des symptômes fonctionnels sans lésion tissulaire. Les critères diagnostiques de l’American College of Rheumatology (ACR 1990) se sont affinés en 2010–2011 et permettent désormais de mieux appréhender les symptômes dans leur globalité et leur sévérité. Les comorbidités émotionnelles et cognitives sont très fréquentes (troubles anxieux, dépression, catastrophisme, hypervigilance, manque de flexibilité, troubles de concentration et de mémoire...). La sensibilisation du système nerveux central est l’hypothèse physiopathologique la plus consensuelle. Les symptômes surviennent sur un terrain favorisant, apparaissent au décours de facteurs précipitants (éventuellement) et sont entretenus et/ou aggravés par des facteurs d’entretien. Différents traitements médicamenteux antalgiques classiques et psychotropes (antiépileptiques et antidépresseurs) ont montré leur efficacité. Des recommandations internationales actualisées sont disponibles. Elles font consensus sur la prise en charge qui doit être multimodale et faire appel à des traitements médicamenteux d’action centrale, associés à des approches psychophysiques et éducatives. L’éducation des patients, comme pour toute pathologie chronique, est donc indispensable.

Abstract

Fibromyalgia is a heavily discussed topic and will continue to be at the centre of debates and disputes in 2015. Nevertheless, it is no longer a matter of questioning this often easily recognisable syndrome (even if the diagnosis is also over-used). The biopsychosocial model enables greater overall understanding and management of chronic conditions, and minimises failures when it comes to patients and care providers. Fibromyalgia is a common condition that mainly effects women, who report having chronic, diffuse muscular, tendon and/or joint pain. This pain is associated with tension headaches, bowel function issues, genitourinary symptoms, tinnitus, temporomandibular joint pain and distal paresthesia, etc. The term somatic symptom disorder is used, which is defined as functional symptoms without any tissue lesions. The American College of Rheumatology (ACR 1990) diagnostic criteria were updated in 2010–2011, which now enables symptoms of this condition to be better understood, both in terms of scope and their severity. Emotional and cognitive comorbidities are very common (anxiety issues, depression, feeling of impending disaster, hypervigilance, lack of flexibility and concentration and memory issues). Sensitization of the nervous system is the most favoured pathophysiological hypothesis for what causes the condition. Symptoms occur when it is favourable, are more likely if there are precipitating factors (possibly) and are sustained and/or worsened by maintenance factors. Different classic and psychoactive (anticonvulsants and antidepressants) pain relief medicines have shown to be effective. Updated international guidelines are available. They provide a consensus on care, which should be multimodal and use centrally active medicinal treatments, combined with psycho-physical and educational approaches. Educating patients, as with all chronic conditions, is undoubtedly fundamental.

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Laroche, F., Guérin, J. Fibromyalgie : où en est-on en 2015 ?. Douleur analg 28, 31–39 (2015). https://doi.org/10.1007/s11724-015-0407-2

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