Différentes études ont observé une difficulté à rester debout (intolérance orthostatique) et une dysfonction du système nerveux autonome qui explique cette difficulté chez les personnes atteintes de fibromyalgie.
Cette dysfonction concerne le baroréflexe qui est l’un des mécanismes responsables de maintenir la pression artérielle constante.
Le système nerveux autonome fait partie du système nerveux périphérique (extérieur au cerveau et à la moelle épinière). Il est responsable des fonctions automatiques de l’organisme telles que la digestion, le rythme cardiaque, la tension artérielle, la transpiration…
Il inclut les systèmes nerveux sympathique et parasympathique qui ont des fonctions opposées et complémentaires. Le système sympathique répond au stress en activant l’organisme, le système parasympathique induit une réponse de relaxation. Les dysfonctions observées dans la fibromyalgie correspondent à une activation excessive du système sympathique.
L’une d’elles est celle du baroréflexe qui régule la pression artérielle à court terme. Sans ce réflexe, il ne serait pas possible de rester debout sans avoir des étourdissements ou des évanouissements. Des récepteurs, les barorécepteurs, qui se trouvent sur des nerfs des vaisseaux sanguins, détectent les changements de pression artérielle et transmettent des influx nerveux qui commandent des ajustements de la dilatation des vaisseaux et de la fréquence cardiaque.
Le baroréflexe est particulièrement important pour l’adaptation à la brusque chute de pression artérielle lors du passage de la position couchée à la position debout alors que la gravité attire le sang vers la partie inférieure du corps.
Antonio Roberto Zamunér et Ester Silva de la Federal University of Sao Carlos(Brésil) ont, avec leurs collègues, mené cette étude avec 35 femmes atteintes de fibromyalgie, âgées en moyenne de 48 ans (+ ou – 9 ans).
Le baroréflexe était évalué au moyen de diverses analyses réalisées à partir de mesures de l’activité cardiaque, de la pression artérielle et de l’activité respiratoire en positions couchée et debout.
L’impact de la fibromyalgie sur la qualité de vie était évaluée avec le Questionnaire d’impact de la fibromyalgie (FIQ) (faites-le test), qui porte notamment sur la capacité à réaliser des tâches quotidiennes, et la douleur était évaluée avec une échelle visuelle.
L’étude conclut que les participantes dont l’activité du baroréflexe était la plus faible en position debout étaient celles dont la fibromyalgie diminuait le plus la qualité de vie et qui rapportaient le plus de douleur.
La difficulté éprouvée en position debout contribuerait, ou du moins serait liée, à la sévérité de la fibromyalgie telle que mesurée par la capacité à fonctionner dans le quotidien (FIQ) et la douleur.
Notons que ce lien peut s’expliquer en soi, mais il peut aussi être renforcé par le fait que le déficit du baroréflexe pourrait être une manifestation de dysfonctions plus généralisées du système nerveux autonome affectant aussi d’autres systèmes.
L’intolérance orthostatique (incapacité de se tenir debout pendant plus qu’une courte période) fait notamment partie des critères diagnostiques du syndrome de fatigue chronique proposés par l’Institute of Medicine (IOM) américain.
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