Fibromyalgie et consultation des centres de référence des maladies rares neuromusculaires : mise à jour des difficultés diagnostiques d'une fibromyalgie primaire et secondaire et accompagnement thérapeutique

Fibromyalgia is a disabling and chronic painful syndrome. Its pathophysiology remains incompletely understood and clinical manifestations may mimic peripheral or central neurological diseases. The richness of complaints usually contrasts with the poorness of examination. Diagnosis is based on the combination of widespread chronic pain, sleep disturbances, fatigue and general symptoms. The diagnosis processes aim to rule out rheumatological or neurological diseases and to assess comorbidities currently associated with fibromyalgia (i.e. anxiety and mood disorders, sleep/wake troubles), which may worsen symptoms and necessitate specific management. The severity of fibromyalgia must be assessed on pain intensity (analogical visual scale) and impact on function and quality of life (an autoquestionnaire like fibromyalgia impact questionnaire may be helpful). The patients have to be explained that therapeutic management is complex and multidisciplinary, including physicians, physiotherapists and psychologists. The therapeutic strategy needs to be adapted to the severity of symptoms, as a combination of patients' education to improve self-efficacy, regular physical activity (supervised if necessary), cognitive and behavioural therapy and pharmacological management of pain and sleep disturbances. It is likely that improvement of quality of life in fibromyalgia needs a better understanding of pathophysiological mechanisms and multidisciplinary therapeutic approach.