La fibromyalgie est le deuxième trouble rhumatismale le plus courant derrière l’arthrose et, bien que encore largement mal comprise, 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 chez ceux qui en souffrent.
Daniel Clauw, M.D., professeur d’anesthésiologie, Université du Michigan, a analysé la base neurologique de la fibromyalgie lors d’une séance plénière aujourd’hui lors de la réunion scientifique annuelle de American Pain Society.
«La fibromyalgie peut être considérée à la fois comme une maladie discrète et aussi comme voie finale commune de la centralisation et de la chronologie de la douleur. La plupart des personnes atteintes de cette affection ont des antécédents de longue durée de la douleur chronique dans leur corps», a déclaré Clauw. “La condition peut être difficile à diagnostiquer si l’on ne connaît pas les symptômes classiques parce qu’il n’y a pas une seule cause et aucun signe extérieur”.
Clauw a expliqué que la douleur de la fibromyalgie vient plus du cerveau et de la moelle épinière que des zones du corps dans lesquelles une personne souffre d’une douleur périphérique. La condition est considérée comme associée à des perturbations dans la façon dont le cerveau traite la douleur et d’autres informations sensorielles. Il a déclaré que les médecins devraient soupçonner la fibromyalgie chez les patients souffrant de douleurs multifocales (principalement musculo-squelettiques) qui ne s’expliquent pas complètement par une blessure ou une inflammation.
“Parce que les voies de la douleur dans tout le corps sont amplifiées chez les patients atteints de fibromyalgie, la douleur peut se produire n’importe où, de sorte que les maux de tête chroniques, la douleur viscérale et l’hypersensibilité sensorielle sont courantes chez les personnes souffrant de cette affection douloureuse”, a déclaré Clauw.
“Cela n’implique pas que l’apport nociceptif périphérique ne contribue pas à la douleur subie par les patients atteints de fibromyalgie, mais ils ressentent plus de douleur que ce qui serait normalement attendu du degré d’apport périphérique. Les personnes atteintes de fibromyalgie et d’autres états de la douleur caractérisés par une sensibilisation ressentiront de la douleur De ce que ceux dont la condition ne décrirait pas comme touch “, a ajouté Clauw.
En raison de l’origine du système nerveux central de la douleur de la fibromyalgie, Clauw a déclaré que les traitements avec des opioïdes ou d’autres analgésiques narcotiques ne sont généralement pas efficaces car ils ne réduisent pas l’activité des neurotransmetteurs dans le cerveau. “Ces médicaments n’ont jamais été considérés comme efficaces chez les patients atteints de fibromyalgie, et il existe des signes selon lesquels les opioïdes pourraient même aggraver la fibromyalgie et d’autres états de la douleur centralisée”, a-t-il déclaré.
Clauw conseille aux cliniciens d’intégrer les traitements pharmacologiques, comme les gabapentinoïdes, les trycycliques et les inhibiteurs de la recapture de la sérotonine, 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 coûteuses dépasse celle des produits pharmaceutiques”, a déclaré Clauw. “Le plus grand bénéfice est la fonction améliorée, qui devrait être le principal objectif de traitement pour toute affection de la douleur chronique. La majorité des patients atteints de fibromyalgie peuvent voir une amélioration de leurs symptômes et mener une vie normale avec les bons médicaments et l’utilisation intensive de thérapies non médicamenteuses. “
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