Fibromyalgie : un déséquilibre cérébral causerait une neuropathie des petites fibres

La fibromyalgie est une condition de douleur chronique dont des mécanismes du système nerveux central ont été bien décrits, expliquent les auteurs d’une étude publiée dans la revue Pain Reports.

Dans la dernière décennie, la neuroimagerie a montré qu’une augmentation de l’activation et de la connectivité fonctionnelle entre des régions cérébrales pronociceptives (qui réagissent aux stimuli nocifs par la douleur), dont l’insula et le cortex cingulaire antérieur, contribuent à la douleur de la fibromyalgie.

Des niveaux élevés de neurotransmetteurs excitateurs (le glutamate) et une diminution des niveaux de neurotransmetteurs inhibiteurs (le GABA) ont également été identifiés dans l’insula des personnes atteintes de fibromyalgie, ce qui suggère qu’un déséquilibre neurochimique entre excitation et inhibition pourrait également jouer un rôle dans la maladie.À l’appui de cette hypothèse, notent les chercheurs, la prégabaline (Lyrica), un traitement ayant une efficacité chez certaines personnes atteintes de la maladie, réduit les taux de glutamate et l’activation polysensorielle dans l’insula.

Plusieurs personnes atteintes de fibromyalgie présentent également une diminution de la densité des fibres nerveuses dans l’épiderme, compatible avec une pathologie des petites fibres. Mais on ne sait toujours pas, expliquent les chercheurs, si l’un ou l’autre de ces mécanismes représente une cause ou une conséquence de l’autre.

Steven E. Harte et Daniel J. Clauw de l’Université du Michigan ont, avec leurs collègues (1), mené cette étude, chez le rongeur, pour vérifier si une augmentation du glutamate est un facteur causal du développement de la neuropathie des petites fibres dans la fibromyalgie.

Ils ont augmenté les niveaux de glutamate endogène dans l’insula des rongeurs (en injectant un inhibiteur du transport de ce neurotransmetteur).

Comparativement au groupe de comparaison, les rongeurs ayant des niveaux plus élevés de glutamate dans l’insula ressentaient la douleur plus facilement. Ils avaient un seuil de douleur à la chaleur plus bas (une chaleur moins élevée entraînait un retrait de la patte), avaient une aversion plus grande d’une stimulation mécanique nocive et présentaient une diminution de la densité des fibres nerveuses de l’épiderme. La réactivité au froid n’était pas altérée par les niveaux plus élevés de glutamate.

Ces résultats précliniques offrent un soutien préliminaire à l’hypothèse selon laquelle l’hyperactivité dans l’insula peut être un facteur causal du développement de la pathologie des petites fibres dans la fibromyalgie, concluent les chercheurs.

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