Fibromyalgie et psychiatrie : 35 ans plus tard… Quoi de neuf ?

Abstract

Fibromyalgia (FM) is a complex disorder that affects 2 to 5% of the general population worldwide at any age and any sex, but more frequently in adult women. The variability of symptoms and the frequency of comorbidities among patients with fibromyalgia make this a difficult disorder to diagnose and treat. New diagnostic criteria are available to improve the diagnosis and care of patients. We propose the first French translation of the new diagnostic criteria proposed by the American College of Rheumatology (ACR) 2010. Although the etiology of fibromyalgia remains unclear, evidences suggest that biologic, genetic and environmental factors are involved. This chronic psychophysical suffering state of fibromyalgia adversely affects the patient's quality of life, performance and mood. Studies report a higher prevalence of psychiatric disorders in patients with fibromyalgia that requires careful history and evaluation for the presence of primary or secondary mood disturbances and psychological stress. Despite the absence of strong evidence of the fibromyalgia pathogenesis, evidence base medecine lead us to consider a biopsychosocial model and a multidisciplinary treatment. Treatment of fibromyalgia requires a comprehensive and multidimensional approach with patient education, cognitive behavior therapy, exercise, physical therapy and pharmacological therapy. Today, the serotonin noradrenaline reuptake inhibitors (milnacipran and duloxetine) and the antiepileptic (pregabalin) are the most effective drugs available for the treatment for fibromyalgia. Therapeutic and pathophysiologic researches seem necessary in this disease and should establish an exemplary model for integrative disease where somatic and psychic form a continuum.