Méthodes non médicamenteuses : compréhension actuelle des mécanismes d'action

The following article summarizes the 2012 SFETD conference presentation. Medication free methods, which include various practices, validated or not yet validated, are labeled “Complementary and Alternative Medicines” (CAM). This article focuses solely on the “Complementary and Alternative Medicines” which include four categories of treatment: natural products (plant based, dietary supplements), mind and body medicine (hypnosis, yoga, meditation), manipulative and body-based practices (osteopathy, chiropractic, massage, pressure massage), and energy medicines (traditional Chinese and Indian medicines). After being disregarded for a long time, CAM are now attracting growing interest both in the scientific literature and from patients since it is estimated that 75% of French patients have used them at least once. However, the 'official' treatment offer is not well identified; a fact revealed by recent official studies. CAM differ from Western medicine conceptually and the holistic approach to the patient on which they are based is perfectly aligned with the necessary methodology for patient pain management: 1) concerning dietary supplements, alpha lipoid acid, acetyl-L-carnitine and vitamin E act at the cellular or metabolic level through calcium channels (AAL), MAP kinases (ALC) or macrophages inhibiting factors (vitamin E). Sometimes partially or fully recognized, these indications are recommended in the treatment of diabetic neuropathies, HIV or post-chemotherapy: 2) mirror therapy, hypnosis and meditation are examples of mind and body therapies. Mirror therapy activates the brain's neuroplasticity and helps augment functional zones after a cerebral vascular accident. Thanks to improvement in functional imaging, the mechanisms of hypnosis are the subject of many publications. The areas of the brain activated under hypnosis are different from those activated while awake, which confirms the significance of the anterior cingulate cortex. Beside these anatomic findings, functional imaging allows for the analysis of the transfer of information in a neural network mode. Meditation is also the subject of interesting research: after only a few training sessions, the activity of the anterior cingulate cortex is modified leading to a diminished feeling of pain. For trained meditators, those modifications are more intense and ubiquitous; 3) when it comes to manipulative and body-based practices, high velocity low amplitude movements used in osteopathy or chiropractic act at the mechanoreceptors level; 4) energy medicines are conceptually different from western medicine. Regarding acupuncture, studies established promising links between traditionally known points and connective tissue arrays planes and connections, which when stimulated by the needle could transmit information all the way to the 'effectors' and lead to the multiple remote effects described in the literature, especially on mu receptors. Auriculotherapy is a type of reflexology with immediate or delayed action based on a somatotopy of the ear. While the mechanism of this somatotopy remains somewhat unclear, evidence in its favor has been observed through neural functional imaging. Finally, the global and holistic approaches of Chinese and Indian medicines are briefly explored. To conclude, CAM are increasingly present in the medical literature and in patients requests. A complete approach to pain is coherent with the integration and better understanding of the working mechanisms and specificities of CAM.