Kahn Marcel-Francis
Service de rhumatologie, hôpital Bichat, 75018 Paris.
Rev Prat. 2003 Nov 15;53(17):1865-72.
Even if associating in single entity polyalgic symptoms remains a matter of discussion, fibromyalgia concept has gained a large acceptance among medical communities and international instances. Its physiopathological background is still in discussion. Its presentation mostly in middle aged women is a chronic, widespread painful syndrome, mostly appendicular of long duration and resistant to any treatment, associated with multiple tender points. Frequently associated are a poor sleep, local and general fatigue and mood disorders. Clinical, biological and radiological search for a definite condition remains negative, at least for primitive presentation. Concomitant forms are accepted by the American College of Rheumatology criteria, position which can be challenged. It seems more accurate to study such cases as differential diagnosis. Physiopathology involves anomalies of perception transmission and integration of painful signals at different levels of nervous system, either peripheral or central. Medical intervention requires first a good deal of empathy and a multidisciplinary approach combining some drugs, insufficient if used alone and different physical cognitive and comportemental measures. Fibromyalgia, which raises difficult social problems, is an evolving concept.
即使将多种疼痛症状归为单一实体仍存在争议，但纤维肌痛的概念已在医学界和国际机构中得到广泛认可。其生理病理背景仍在讨论中。它主要表现为中年女性的一种慢性、广泛的疼痛综合征，主要累及四肢，病程长且对任何治疗都有抵抗性，并伴有多个压痛点。常伴有睡眠不佳、局部和全身疲劳以及情绪障碍。临床、生物学和放射学检查均未发现明确病因，至少对于原发性表现是如此。美国风湿病学会的标准认可了合并症形式，但这一立场可能受到质疑。将此类病例作为鉴别诊断来研究似乎更为准确。生理病理学涉及疼痛信号在神经系统不同水平（外周或中枢）的感知传递和整合异常。医学干预首先需要充分的同理心和多学科方法，联合使用一些药物（单独使用效果不佳）以及不同的物理、认知和行为措施。纤维肌痛引发了棘手的社会问题，是一个不断发展的概念。
