Maugars Yves, Berthelot Jean-Marie, Le Goff Benoit, Darrieutort-Laffite Christelle
Rheumatology Department, Nantes University Hospital, Nantes, France.
Front Med (Lausanne). 2021 Jul 14;8:666914. doi: 10.3389/fmed.2021.666914. eCollection 2021.
The concept of fibromyalgia has progressed to achieve a certain consensus regarding the definition of the condition. We summarize what is known in 2020, be it in terms of diagnosis, with the criteria that have changed over the years, or at the level of the psychological profile, via the notions of "catastrophizing" and "coping" and post-traumatic syndrome. The importance of fatigue and sleep disorders is underlined, with the chronological sequence of post-traumatic syndrome, chronic fatigue, and then amplification of the pain and the onset of multiple associated symptoms. The etiopathogenic debate has been enriched thanks to neuro-imaging data to discover the start of the central neurological signature. The many associated symptoms are reanalyzed in the context of so-called sister conditions which form sometimes more or less separate entities, such as chronic fatigue syndrome or restless legs syndrome for example. What these conditions have in common is hypersensitivity, not just to pain, but also to all exteroceptive stimuli, from deep sensitivity in the neuro-vegetative system, the sense organs and certain functions of the central nervous system, to the psychological aspects and sleep control. In summary, it is possible to define fibromyalgia as a cognitive disorder of cortical integration of chronic pain, with amplification of painful and sensory nociception, decrease in the threshold for the perception of pain, and persistence of a stimulus that maintains the process in chronicity. Fibromyalgia is part of a group of chronic hypersensitivity syndromes of central origin, with a very wide range of means of expression.
纤维肌痛的概念已经发展到就该病症的定义达成了一定共识。我们总结了2020年已知的情况，无论是在诊断方面，多年来标准发生了哪些变化，还是在心理特征层面，通过“灾难化”“应对”和创伤后综合征等概念。疲劳和睡眠障碍的重要性得到了强调，以及创伤后综合征、慢性疲劳的时间顺序，随后是疼痛加剧和多种相关症状的出现。由于神经影像学数据，病因学争论得以丰富，从而发现了中枢神经特征的起始。在所谓的姐妹病症背景下重新分析了许多相关症状，这些病症有时或多或少形成独立的实体，例如慢性疲劳综合征或不安腿综合征。这些病症的共同之处在于超敏反应，不仅对疼痛，而且对所有外部感受刺激，从神经植物系统、感觉器官和中枢神经系统的某些功能的深度敏感性，到心理方面和睡眠控制。总之，可以将纤维肌痛定义为慢性疼痛的皮质整合认知障碍，伴有疼痛和感觉伤害感受的放大、疼痛感知阈值降低以及维持该过程慢性化的刺激持续存在。纤维肌痛是一组中枢起源的慢性超敏综合征的一部分，具有非常广泛的表现形式。
