Finalement, la fibromyalgie a été considérée comme un trouble du système nerveux central à vie

La fibromyalgie est le deuxième trouble rhumatismale la plus fréquente derrière l’arthrose et, quoique encore très mal compris, est maintenant considéré comme un trouble du système nerveux central à vie, qui est responsable de la douleur amplifiée qui tire à travers le corps dans ceux qui en souffrent. Daniel Clauw, MD, professeur d’anesthésiologie, Université du Michigan, a analysé la base neurologique pour la fibromyalgie dans une adresse de la session plénière aujourd’hui à la réunion scientifique annuelle de la Société américaine de la douleur.

 

« Fibromyalgie peut être considéré à la fois comme une maladie discrète et aussi comme une voie commune finale de la centralisation de la douleur et la chronicité. La plupart des personnes atteintes de cette maladie ont des histoires à vie de la douleur chronique tout au long de leur corps « , a déclaré Clauw. « La condition peut être difficile à diagnostiquer si on ne connaît pas les symptômes classiques, car il n’y a pas une cause unique et aucun signe extérieur. »

Clauw a expliqué que la douleur de la fibromyalgie vient plus du cerveau et la moelle épinière que des zones du corps où une personne peut éprouver de la douleur périphérique. La condition est censé être associé à des perturbations dans la façon dont le cerveau traite la douleur et d’autres informations sensorielles. Il a dit les médecins devraient soupçonner la fibromyalgie chez les patients atteints multifocale (la plupart du temps musculo-squelettique) douleur qui ne sont pas explicitées par une blessure ou une inflammation.

« Parce que les voies de la douleur dans tout le corps sont amplifiés chez les patients atteints de fibromyalgie, la douleur peut se produire partout, si les maux de tête chroniques, la douleur viscérale et hyperréactivité sensorielle sont fréquentes chez les personnes atteintes de cette maladie douloureuse », a déclaré Clauw.

« Cela ne signifie pas que l’entrée nociceptive périphérique ne contribue pas à la douleur ressentie par les patients atteints de fibromyalgie, mais ils ne se sentent plus de douleur que normalement prévu à partir du degré périphérique d’entrée. Les personnes atteintes de fibromyalgie et d’autres états douloureux caractérisés par une sensibilisation connaîtront la douleur de ce que ceux sans la condition décriraient comme toucher « , a ajouté Clauw.

En raison de l’origine du système nerveux central de la douleur de la fibromyalgie, Clauw dit traitements avec des opioïdes ou d’autres analgésiques narcotiques ne sont généralement pas efficaces parce qu’ils ne réduisent pas l’activité des neurotransmetteurs dans le cerveau. « Ces médicaments ont jamais été révélés efficaces chez les patients atteints de fibromyalgie, et il y a des preuves que les opioïdes pourraient même aggraver la fibromyalgie et d’autres états de douleur centralisée », at-il dit.

Clauw conseille aux cliniciens d’intégrer les traitements pharmacologiques, tels que gabapentinoïdes, Trycyclics et inhibiteurs du recaptage de la serotonoin, avec des approches non pharmacologiques comme la thérapie cognitivo-comportementale, l’exercice et la réduction du stress.

« Parfois, l’ampleur de la réponse au traitement pour les thérapies non médicamenteuses simples et peu coûteux est supérieure à celle des produits pharmaceutiques », a déclaré Clauw. « Le plus grand avantage est amélioré la fonction, ce qui devrait être le principal objectif de traitement pour toute condition de douleur chronique. La majorité des patients atteints de fibromyalgie peut voir une amélioration de leurs symptômes et mener une vie normale avec les bons médicaments et l’utilisation intensive des thérapies non médicamenteuses « .

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