École interactionnelle de fibromyalgie un traitement multidisciplinaire pour une population hétérogène

Abstract

Pain is a sensory, emotional, and subjective perception associated with a real or potential tissue lesion. In some pathological conditions, pain can occur without a lesion, as in the case of chronic pain. The fibromyalgia (FM) syndrome is an example of this. Of unclear etiology and predominantly found in women (6 [symbole féminin] :1 [symbole masculin] ), FM is characterized by widespread pain and muscle tenderness often accompanied by fatigue, stiffness, non-restorative sleep, mood disturbance, and a lack of concentration and memory. Multidisciplinary approaches are used more and more to treat FM, despite a lack of proof of their long-term efficacy and despite the large inter-subject variability regarding improvement. In the treatment of chronic low-back pain, our prior studies have demonstrated a durable reduction in pain (up to 6 months) with a multidisciplinary structured program (Interactional School for Low-back Pain) based on the principal of brief and strategic therapy. The present study aimed to create and evaluate a multidisciplinary structured program based on the same principals as those of the Interactional School for Low-back Pain. This program, called the Interactional School of Fibromyalgia (ISF) consists of nine weekly group meetings. The goal is to increase the capacity to self-manage FM symptoms. The participants were randomly placed into one of 2 groups: the experimental group which followed the ISF and the control group which remained on the waiting list. These participants were followed up until one year after the end of the treatment (ISF). The results demonstrated that the ISF produced changes that were durable (one year after) and considerable both for the experimental measures (reduction in mechanical allodynia and increased pain threshold at the FM sensitive points) and for clinical measures (reduced impact of FM and reduced clinical pain). The results are important for several reasons. Not only is the improvement significant but it is also persistent after treatment and the abandon rate was only 3%. In addition, cluster analysis of the results led to the identification of two sub-groups of FM patients distinguishable by two psychological characteristics: anxiety and depression. This distinction could explain in large part the heterogeneity of the clinical manifestations of FM. Thus, this study provides a new and simple method to identify the sub-groups of FM patents. In conclusion, we attribute the positive results to the following characteristics of the ISF : the inclusion of original themes such as breathing techniques and nutrition; the application of interactional principles such as maximising the therapeutic relationship (same 2 facilitators, here physiotherapist and nurse, during the entire ISF); the use of a flexible and personalized program pertinent to a heterogeneous group (which could include both depressed and non depressed, working and unemployed patients).