[Psychocorporal approach to functional somatic disorders]. / Prise en charge psychocorporelle des troubles somatiques fonctionnels.

Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.

Evaluation of the Effectiveness of Wet Cupping Therapy in Fibromyalgia Patients: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to investigate the efficacy of wet cupping therapy (WCT) in patients diagnosed with fibromyalgia syndrome (FMS) as a complementary method in fibromyalgia treatment. MATERIALS AND METHODS: A total of 120 participants between 18 and 65 years who were diagnosed with FMS were included in the study. They were randomized into two groups: 60 patients as the intervention and 60 patients as the control group. Each participant in the intervention group received 3 sessions of WCT once a month in addition to their ongoing treatment whereas the control group received only routine medical treatment. The evaluation was conducted in both groups based on the fibromyalgia impact questionnaire (FIQ), visual analog scale (VAS), and quality of life scale (QoL) parameters initially (at 0th week) and 1 week after the WCT sessions (at the 10th week). For the comparison of quantitative variables showing a normal distribution between the two groups, the Student's t test was used, while the Mann-Whitney U test was employed for variables not showing a normal distribution. The χ2 test and Continuity (Yates) Correction were used for the comparison of qualitative data. The significance level was set at p < 0.05. RESULTS: The study included 107 female and 13 male participants, with a mean age of 45.79 ± 8.49 years. When comparing the pretreatment FIQ, VAS, and QoL scores with the scores obtained after three sessions of WCT, it was observed that in the WCT group, the FIQ and VAS values significantly decreased compared to the control group while the QoL significantly increased compared to the control group (p < 0.001 in all). CONCLUSION: The findings obtained from this study indicate that WCT can be an effective treatment option for patients with FMS.Mit dieser Studie soll die Wirksamkeit der blutigen Schröpftherapie (wet cupping therapy, WCT) bei Patienten mit diagnostiziertem Fibromyalgie-Syndrom (FMS) als komplementäre Methode in der Fibromyalgie-Behandlung untersucht werden.Insgesamt wurden 120 Teilnehmer mit diagnostiziertem FMS zwischen 18 und 65 Jahren in die Studie aufgenommen. Diese wurden randomisiert zwei Gruppen zugeordnet: 60 Patienten wurden der Interventionsgruppe zugewiesen und 60 Patienten der Kontrollgruppe. Alle Teilnehmer der Interventionsgruppe erhielten einmal im Monat drei Sitzungen WCT zusätzlich zu ihrer laufenden Therapie, während die Kontrollgruppe lediglich die Standardbehandlung erhielt. Die Bewertung erfolgte in beiden Gruppen anhand des Fibromyalgia Impact Questionnaire (FIQ), der Visuellen Analogskala (VAS) und der Parameter der Quality of Life (QoL) Scale zu Beginn (in Woche 0) und eine Woche nach den WCT-Sitzungen (in Woche 10). Für den Vergleich von quantitativen Variablen, die eine Normalverteilung zwischen den beiden Gruppen aufwiesen, wurde der Student's t-Test verwendet, während bei Variablen ohne Normalverteilung der Mann-Whitney-U-Test zur Anwendung kam. Qualitative Daten wurden mit dem Chi-Quadrat-Test und der Kontinuitätskorrektur (Yates) verglichen. Das Signifikanzniveau wurde auf p < 0,05 festgelegt.In die Studie wurden 107 Frauen und 13 Männer mit einem Durchschnittsalter von 45,79 ± 8,49 Jahren aufgenommen. Beim Vergleich der FIQ-, VAS- und QoL-Werte vor der Behandlung mit den nach drei WCT-Sitzungen erhobenen Werten zeigte sich in der WCT-Gruppe ein signifikanter Rückgang der FIQ- und VAS-Werte im Vergleich zur Kontrollgruppe, wohingegen bei der QoL ein signifikanter Anstieg gegenüber der Kontrollgruppe zu beobachten war (p < 0,001 in allen Fällen).Die Ergebnisse dieser Studie deuten darauf hin, dass die WCT eine wirksame therapeutische Option für Patienten mit FMS sein kann.

Catastrophizing and rumination mediate the link between functional disabilities and anxiety/depression in fibromyalgia. A double-mediation model.

Fibromyalgia can be considered to be a model of chronic pain resulting from dysregulation of pain processing. From a psychological point of view, it is possible to consider transdiagnostic processes that would participate in both the dysregulation of pain and associated emotions. OBJECTIVE: The aim of this study was to test the links that exist between the tendency to Repetitive Negative Thinking (RNT) and the anxious-depressive manifestations in fibromyalgia. More specifically, we wanted to test a double mediation model where RNT would mediate the link between pain and depression/anxiety via catastrophizing. METHOD: Eighty-two patients with fibromyalgia completed a series of questionnaires evaluating their level of depression, anxiety, disability related to pain, catastrophizing as well as various measures of Repetitive Thoughts. RESULTS: The results showed strong correlations between RNT levels, pain, and anxious-depressive manifestations in this population. Moreover, the links between pain and depression/anxiety were mediated by catastrophizing and RNT in serial. CONCLUSION: Results support the interest of studying RNT as a transdiagnostic process in fibromyalgia pain. Considering RNT in fibromyalgia allows a better understanding of tthe links that exist between pain and emotional disorders in this population and thus to better understand the psychopathological comorbidity of fibromyalgia.

[Ketamine use in outpatients: What can we learn from current practices?] / Utilisation de la kétamine chez les patients ambulatoires : que pouvons-nous apprendre des pratiques actuelles ?

INTRODUCTION: Two off-label use of ketamine are framed by recommendations: in intractable pain in palliative situations or in postoperative pain. Ketamine is used in hospital but can also be used outside hospital with dispensations by hospital pharmacy to outpatients. Few data are available on ketamine use outside hospital. In this context, the French Addictovigilance Network has set up a study with hospital pharmacies. MATERIALS AND METHODS: This survey assesses ketamine dispensations from 1 January to 30 April 2019, for patients who have an administration of ketamine outside hospital. RESULTS: Sixty-five (65) hospital pharmacies have dispensed ketamine for 553 patients. Ketamine was indicated within non-palliative care in 86% of cases. Most of non-cancer pain were in fibromyalgia (44%) and neuropathic pain (29%). During the 4-month monitoring period, 1352 dispensations were analysed. The frequency of administration is daily in 91% of cases within palliative care whereas it is much more diverse within non-palliative care (33% daily, more than 15 different frequency in fibromyalgia). Within palliative care, ketamine is most administered intravenously or by Patient Controlled Analgesia or syringe pump (78% of cases) whereas in non-palliative care, ketamine is most used subcutaneously (44%), orally (32%) or both subcutaneously and orally (20%). A large number of ampoules could be dispensed (more than 30 ampoules for 10% of dispensations). CONCLUSION: These data highlighted that recommendation in pain are not respected because most of ketamine is used within non-palliative care context and it should be noted a great heterogeneity of practice. This study underlines the urgency of targeted and clear information on certain off-label uses of ketamine for which no robust clinical studies are available and for which the risk of health complications like psychiatric (addiction), urologic and hepatologic complications is proven.

Fibromyalgie en réeducation fonctionnelle à Cotonou: caractéristiques et vécu socio-professionnel des patients / NA

La fibromyalgie est une affection de douleur chronique, peu connue sous les tropiques. Elle pourrait altérer le vécu quotidien des patients. Objectif : Présenter les caractéristiques des cas de fibromyalgie suivis en Médecine Physique et de Réadaptation au CNHU-HKM de Cotonou, de même que le retentissement socio-professionnel noté chez ces patients. Méthode : Etude transversale de type descriptif ayant porté sur 60 patients diagnostiqués fibromyalgiques selon les critères de l'ACR 1990 et suivis en rééducation fonctionnelle du CNHU-HKM du 31 décembre 2009 au 30 Avril 2015. Ces patients ont été réévalués du 31 octobre 2014 au 30 Avril 2015 avec l'auto-questionnaire de Dallas pour apprécier le retentissement socio-professionnel de leur affection. Résultats : L'âge moyen des patients a été de 48,55 ans. Il s'agissait de 91,7% de femmes. La douleur était de type variable. Sa durée d'évolution était en moyenne de 89,38±74,77 mois. Elle était d'installation progressive (73,4%), intermittente (50%) et d'intensité au moins forte (88,4%). Des points douloureux spécifiques ont été identifiés dans notre série. La principale étiologie évoquée par les patients était la dépression et l'anxiété (95%). Un important retentissement des activités quotidiennes, professionnelles et des interactions sociales a été noté chez la majorité des patients. Conclusion : Les répercussions de la fibromyalgie sur les patients sont assez marquées. Il paraît judicieux d'associer à la rééducation un accompagnement psycho-social chez ces patients.

Moving towards Soul - an alchemical journey. Rehabilitation of women suffering from 'chronic pain' in a clinical and Jungian context.

The aim of this paper is to explore the connection between symptom and symbol in the body of women suffering from chronic pain, diagnosed as fibromyalgia. The working hypothesis has been that the symbol that emerges from the symptom in the body can bridge the gap to a deeper meaning of pain and suffering, thereby becoming the agent of change for healing of the bodymind and the experience of pain in the physical body. To explore this subject I will introduce some recent research from the field of fibromyalgia, and the concepts of agency and affect systems in the body, which are important cornerstones in my work. I will briefly present my clinical concept of 'Form and Freedom'. From this theoretical base I give some clinical examples of what I see as an alchemical journey towards soul, presented through vignettes, images and the words of three women - Maria, Riba and Ishtar. I conclude with how I see analytical psychology taking its rightful place alongside, informing or in conjunction with, as in my case, other psychotherapeutic modalities, working in creative ways that enhance healing in patients who suffer from chronic pain.

Le but de cet article est d'explorer le lien entre le symptôme et le symbole dans le corps de femmes souffrant de douleurs chroniques, diagnostiquées comme fibromyalgie. L'hypothèse de travail a été que le symbole qui émerge du symptôme dans le corps peut fournir une passerelle pour aller vers un sens plus profond de la douleur et de la souffrance, devenant ainsi l'élément du changement dans la guérison du corps-esprit et de l'expérience de la douleur dans le corps physique. Afin d'explorer ce sujet je présenterai des recherches récentes dans le champ de la fibromyalgie. Je présenterai aussi le concept des systèmes d'affect et d'éléments de changement dans le corps, qui sont des pierres angulaires dans mon travail. Je présenterai brièvement mon concept clinique « Forme and Liberté ¼. A partir de ce support théorique je donnerai quelques exemples cliniques de ce que je vois comme un voyage alchimique vers l'âme, ceci par des vignettes, images et paroles de trois femmes - Maria, Riba et Ishtar. Je conclue en évoquant comment je vois la psychologie analytique prendre sa place légitime parmi d'autres modalités psychothérapeutiques, informant celles-ci ou leur apportant simplement son concours, comme c'est le cas dans mon travail, travaillant de manière créative à soutenir la guérison chez des patientes souffrant de douleurs chroniques.

El objetivo de este trabajo es explorar la conexión entre síntoma y símbolo en el cuerpo de mujeres que padecen dolor crónico, diagnosticado como fibromialgia. La hipótesis de trabajo es que el símbolo que emerge desde el síntoma en el cuerpo puede tender un puente hacia un sentido más profundo del dolor y el sufrimiento, por lo tanto volviéndose un agente de cambio para la sanación del cuerpomente y la experiencia de dolor en el cuerpo físico. Para explorar este tema, voy a introducir algunas investigaciones recientes del campo de la fibromialgia, y los conceptos de sistemas de agencia y de emoción en el cuerpo, los cuales son piedras fundamentales en mi trabajo. Introduciré brevemente mi concepto clínico de 'Forma y Libertad'. A partir de esta base teórica, presento ejemplos clínicos de aquello que comprendo como un viaje alquímico hacia el alma, presentado a través de viñetas, imágenes y el trabajo de tres mujeres - María, Riba e Ishtar. Concluyo con mi percepción respecto a cómo la psicología analítica puede tomar su debido lugar, informando o en forma conjunta con, otras modalidades psicoterapéuticas, trabajando de maneras creativas para enaltecer la curación en pacientes que sufren de dolor crónico.

[Expressing the body to understand pain]. / Dire le corps pour mieux appréhender la douleur.

Nurses are involved in the treatment of pain through its evaluation, the collection of data and the administering of prescribed treatments. They often get to see the link with the patient's life history, and the depression and anxiety so frequently associated with chronic pain. In pain consultations, the clinical psychologist forms part of the team work by encouraging patients to express themselves. Expressing the body can serve as a springboard to psychotherapeutic effects as illustrated here by a clinical case.

[One or more functional somatic syndromes? Comparison of the health status of fibromyalgia and electro-hypersensitive people]. / Un ou plusieurs syndromes somatiques fonctionnels ? Comparaison de l'état de santé de personnes fibromyalgiques et électro-hypersensibles.

INTRODUCTION: Functional somatic syndromes, grouping somatic symptoms without an organic explanation, are defined either by their predominant symptoms or by an attribution to an, often hypothetical, cause. Due to many similarities, some authors consider that there is only one FSS due to a general phenomenon of "somatization". The objective of this work was to compare two functional somatic syndromes, one defined by its symptoms, fibromyalgia, and the other by a specific contested attribution, electro-hypersensitivity. METHOD: Fibromyalgia or electro-hypersensitive participants (EHS) were recruited from September 2016 to April 2017 through associations of patients in Auvergne-Rhône-Alpes. Home interviews included the collection of medical, psychopathological, and symptom histories. The assessment of psychological distress, quality of life and the search for other functional somatic syndromes was performed through structured questionnaires, self-administrated scales, and clinical examination. RESULTS: Sixteen fibromyalgia subjects and sixteen EHS subjects were included. There are differences in symptomatology, although many symptoms are common to both conditions. Lifetime history of psychiatric disorders and current psychological distress and psychopathology are frequent in both groups but more prevalent in fibromyalgia subjects. The experience of the symptoms, their interpretation, the diagnostic itineraries and the therapeutic behaviours differ radically according to the group, even if for all socio-professional impact is high and quality of life are altered. CONCLUSION: The health status of fibromyalgia persons is overall worse than the health status of electro-hypersensitive individuals in this small sample. Despite the overlap in symptoms and a similar impact on daily functioning, this exploratory study suggests that heterogeneous mechanisms of "somatization" may be at stake in functional somatic syndromes.

Management of patients presenting with generalized musculoskeletal pain and a suspicion of Lyme disease.

Lyme disease is caused by bacteria of the B. burgdorferi sensu lato complex, and can give polymorphic clinical manifestations that can affect several organs such as the skin, the central nervous system, or the joints. In recent years, patients' associations and physicians have been supporting the hypothesis that this infection would manifest as chronic generalized musculoskeletal pain symptoms, named "chronic Lyme disease". Fibromyalgia is a clinical presentation characterized by chronic generalized musculoskeletal pain with a major impact on quality of life and social and psychological functioning. We analyzed existing literature data on pain syndromes associated with Lyme disease (post-treatment Lyme disease syndrome) or tick bites (polymorphic symptoms after a tick bite). We also analyzed existing data on the diagnosis, pathophysiology, and treatment of fibromyalgia. Our review shows that post-treatment Lyme disease syndrome has characteristics very close to post-infectious fibromyalgia. On the other hand, patients presenting for Lyme disease screening because of chronic generalized musculoskeletal pain symptoms after a tick bite should also be screened for fibromyalgia to allow appropriate management. Antibiotics are not recommended here.

Functional neuroimaging in patients presenting with somatoform disorders: A model for investigating persisting symptoms after tick bites and post-treatment Lyme disease syndrome?

Approximately 10% of patients presenting with Lyme disease experience fatigue, musculoskeletal pain, concentration disorders, or short-term memory deficits in the six months following treatment. This entity has been defined as post-Lyme disease syndrome or post-treatment Lyme disease syndrome. The pathophysiology of this syndrome is unknown, but neither persistence of the bacterium nor effectiveness of antibiotics are currently reported in the literature. The French High Council for Public Health (French acronym HCSP) has recently defined a new entity called "persistent polymorphic symptoms after a tick bite" allowing for designing studies to better understand these subjective presentations, for which objective biomarkers are currently lacking. This entity encompasses patients experiencing fatigue and generalized pain in the months following a tick bite and can be associated with several subjective symptoms with major impact on the quality of life. In the field of somatoform disorders, this article reviews functional neuroimaging studies in patients presenting with subjective complaints and discusses potential clinical implications for persisting symptoms after tick bites and post-treatment Lyme disease syndrome.

[Small fiber neuropathy]. / La neuropathie des petites fibres.

Small fiber neuropathy (SFN) is still unknown. Characterised by neuropathic pain, it typically begins by burning feet, but could take many other expression. SFN affects the thinly myelinated Aδ and unmyelinated C-fibers, by an inherited or acquired mechanism, which could lead to paresthesia, thermoalgic disorder or autonomic dysfunction. Recent studies suggest the preponderant role of ion channels such as Nav1.7. Furthermore, erythromelalgia or burning mouth syndrome are now recognized as real SFN. Various aetiologies of SFN are described. It could be isolated or associated with diabetes, impaired glucose metabolism, vitamin deficiency, alcohol, auto-immune disease, sarcoidosis etc. Several mutations have recently been identified, like Nav1.7 channel leading to channelopathies. Diagnostic management is based primarily on clinical examination and demonstration of small fiber dysfunction. Laser evoked potentials, Sudoscan®, cutaneous biopsy are the main test, but had a difficult access. Treatment is based on multidisciplinary management, combining symptomatic treatment, psychological management and treatment of an associated etiology.

The treatment of fatigue by non-invasive brain stimulation.

The use of non-invasive brain neurostimulation (NIBS) techniques to treat neurological or psychiatric diseases is currently under development. Fatigue is a commonly observed symptom in the field of potentially treatable pathologies by NIBS, yet very little data has been published regarding its treatment. We conducted a review of the literature until the end of February 2017 to analyze all the studies that reported a clinical assessment of the effects of NIBS techniques on fatigue. We have limited our analysis to repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). We found only 15 studies on this subject, including 8 tDCS studies and 7 rTMS studies. Of the tDCS studies, 6 concerned patients with multiple sclerosis while 6 rTMS studies concerned fibromyalgia or chronic fatigue syndrome. The remaining 3 studies included patients with post-polio syndrome, Parkinson's disease and amyotrophic lateral sclerosis. Three cortical regions were targeted: the primary sensorimotor cortex, the dorsolateral prefrontal cortex and the posterior parietal cortex. In all cases, tDCS protocols were performed according to a bipolar montage with the anode over the cortical target. On the other hand, rTMS protocols consisted of either high-frequency phasic stimulation or low-frequency tonic stimulation. The results available to date are still too few, partial and heterogeneous as to the methods applied, the clinical profile of the patients and the variables studied (different fatigue scores) in order to draw any conclusion. However, the effects obtained, especially in multiple sclerosis and fibromyalgia, are really carriers of therapeutic hope.

[Chronic fatigue syndrome: A new disorder?] / Le syndrome de fatigue chronique : une nouvelle maladie ?

More than 30 years after its individualization, chronic fatigue syndrome (CFS) remains a debilitating condition for the patient and a confusing one to the physicians, both because of diagnostic difficulties and poorly codified management. Despite the numerous work carried out, its pathophysiology remains unclear, but a multifactorial origin is suggested with triggering (infections) and maintenance (psychological) factors as well as the persistence of inflammatory (low grade inflammation, microglial activation…), immunologic (decrease of NK cells, abnormal cytokine production, reactivity to a variety of allergens, role of estrogens…) and muscular (mitochondrial dysfunction and failure of bioenergetic performance) abnormalities at the origin of multiple dysfunctions (endocrine, neuromuscular, cardiovascular, digestive…). The complexity of the problem and the sometimes contradictory results of available studies performed so far are at the origin of different pathophysiological and diagnostic concepts. Based on a rigorous analysis of scientific data, the new American concept of Systemic Disease Exertion Intolerance proposed in 2015 simplifies the diagnostic approach and breaks with the past and terminologies (CFS and myalgic encephalomyelitis). It is still too early to distinguish a new disease, but this initiative is a strong signal to intensify the recognition and management of patients with CFS and stimulate research.

Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software.

PURPOSE: We measured the amount of hemoglobin at the optic nerve head of fibromyalgia (FM) patients using new colorimetric analysis software. We also investigated whether perfusion defects of the optic nerve head in patients with FM lead to tissue atrophy and corresponding retinal nerve fiber layer (RNFL) thinning measured by optical coherence tomography (OCT). METHODS: We recruited for this cross-sectional study 118 FM patients and 76 sex- and age-matched healthy controls. All subjects underwent a complete neuro-ophthalmologic examination, which also included visual field testing using the Spark strategy in an Easyfield perimeter, and OCT examinations using the Spectralis. One photograph of the optic disc was obtained using a Cirrus™ Photo 800 multi-modality imager. We analyzed fundus photographs using Laguna ONhE software, a new method that allows hemoglobin levels to be measured at the optic nerve head. We compared hemoglobin percentages in different sectors of the nerve head and RNFL thicknesses between the two groups. RESULTS: Mean hemoglobin percentages and hemoglobin content in all optic nerve head sectors calculated by the Laguna ONhE program were significantly lower in FM patients than in healthy controls, and the main differences were detected in the outer ring, which corresponds with the neuroretinal rim. However, only the differences in the superotemporal RNFL were statistically significant. Correlations between the RNFL thickness and the percentage of hemoglobin in the different sectors were weak. CONCLUSION: Optic disc perfusion was decreased in patients with FM, especially within the neuroretinal rim, without clear involvement in the RNFL.

Um sujeito no mercado das pílulas / A subject at the pill market / Un sujet au marché des pilules / Un sujeto en el mercado de las pastillas

O consumo iguala todos como semelhantes, a partir de soluções para -todos, desconsiderando a particularidade da subjetividade. O fibromiálgico recusa o tratamento universal ofertado pela ciência, seu tratamento deve respeitar a lógica do caso a caso. A discussão proposta se ancora em dados clínicos para pensar a especificidade de uma subjetividade, para além da patologia, forjada a partir de uma ordem de ferro, em tempos de declínio do poder norteador do amor ao pai.

Consumption treats everyone in the same way and offers solutions for all regardless of individuality. But fibromyalgia patients refuse this kind of treatment offered by science. Their treatment requires a study of each case. This paper, based on clinical data, brings up the question of subjectivity and its idiosyncrasies, beyond pathology, in a context of iron in times of decay of the guiding power of the father's love.

La consommation nous rend tous égaux, tous semblables, étant donné ses solutions pour tous qui ne prennent pas en compte la particularité de la subjectivité. La fibromyalgie refuse tout traitement universel offert par la science, son traitement suit la logique du cas particulier. La discussion proposée ici est basée sur des données cliniques et porte sur la spécificité d'une subjectivité qui va au-delà de la pathologie et qui est construite à partir d'un ordre de fer, en ces temps de déclin du pouvoir d'orientation de l'amour au père.

El consumo iguala a todos como semejantes a partir de soluciones para todo el mundo, sin tener en cuenta la particularidad de la subjetividad. Los pacientes con fibromialgia rechazan el tratamiento universal que la ciencia les ofrece, su tratamiento debe respetar la lógica del caso por caso. La discusión que se propone se basa en datos clínicos para pensar la especificidad de una subjetividad, más allá de la patología, forjada a partir de un orden férro en tiempos de decadencia del poder orientador del amor al padre.

Um sujeito no mercado das pílulas / A subject at the pill market / Un sujet au marché des pilules / Un sujeto en el mercado de las pastillas

O consumo iguala todos como semelhantes, a partir de soluções para-todos, desconsiderando a particularidade da subjetividade. O fibromiálgico recusa o tratamento universal ofertado pela ciência, seu tratamento deve respeitar a lógica do caso a caso. A discussão proposta se ancora em dados clínicos para pensar a especificidade de uma subjetividade, para além da patologia, forjada a partir de uma ordem de ferro, em tempos de declínio do poder norteador do amor ao pai.(AU)

Consumption treats everyone in the same way and offers solutions for all regardless of individuality. But fibromyalgia patients refuse this kind of treatment offered by science. Their treatment requires a study of each case. This paper, based on clinical data, brings up the question of subjectivity and its idiosyncrasies, beyond pathology, in a context of iron in times of decay of the guiding power of the father's love.(AU)

La consommation nous rend tous égaux, tous semblables, étant donné ses solutions pour tous qui ne prennent pas en compte la particularité de la subjectivité. La fibromyalgie refuse tout traitement universel offert par la science, son traitement suit la logique du cas particulier. La discussion proposée ici est basée sur des données cliniques et porte sur la spécificité d'une subjectivité qui va au-delà de la pathologie et qui est construite à partir d'un ordre de fer, en ces temps de déclin du pouvoir d'orientation de l'amour au père.(AU)

El consumo iguala a todos como semejantes a partir de soluciones para todo el mundo, sin tener en cuenta la particularidad de la subjetividad. Los pacientes con fibromialgia rechazan el tratamiento universal que la ciencia les ofrece, su tratamiento debe respetar la lógica del caso por caso. La discusión que se propone se basa en datos clínicos para pensar la especificidad de una subjetividad, más allá de la patología, forjada a partir de un orden férro en tiempos de decadencia del poder orientador del amor al padre.(AU)

A fibromialgia e a manifestação de sofrimento psíquico / Fibromyalgia and the manifestation of mental suffering / Fibromialgia y la manifestación de sufrimiento psíquico / Fibromyalgie et la manifestation de la souffrance psychique

A fibromialgia se caracteriza por dor muscular crônica que atinge uma ampla extensão do aparato corporal. A vivência dolorosa na fibromialgia implica uma redução das capacidades funcionais, distúrbios do sono e prejuízos às relações de sociabilidade. A etiologia pode compreender fenômenos psicogênicos primários e secundários relacionados aos quadros álgicos. Os fenômenos primários são investigados a partir da proposição de afecções psicossomáticas e de sintomas conversivos. Já os fenômenos secundários envolvem quadros depressivos. Realizou-se uma intervenção psicoterapêutica com cinco mulheres afastadas do trabalho pelo diagnóstico de fibromialgia. Utilizou-se a proposta psicanalítica do grupo de mediação para a escuta e a continência das vivências conflituosas e dinâmicas de isolamento social potencializadas pelo adoecimento. Distanciadas dos valores atribuídos aos corpos eficientes produzidos pelo trabalho relacionavam-se com o afastamento como algo pejorativo. Este posicionamento proporcionava vivências ansiogênicas com características depressivas. A representação dos afetos no espaço estabelecido pelo grupo permitiu a expressão simbólica do sofrimento, a delimitação das situações que intensificavam as dores e o relato da dor corporal, como "uma podridão do corpo" que barrava a articulação das atividades cotidianas. Ao oferecer acolhimento e ressignificação aos afetos, a atenção psicoterapêutica contribuiu para a manutenção do quadro geral de saúde, amenizando vivências dissociativas e levando a reflexões sobre formas de atendimento interdisciplinar.(AU)

Fibromyalgia is characterized by chronic muscle pain that affects a wide extension of the body. Pain experiences in fibromyalgia imply a reduction of functional capacity, sleep disturbances and loss of social relations. Its etiology may include primary and secondary psychogenic phenomena related to pain. Primary phenomena are investigated from the proposition of psychosomatic disorders and hysteria symptoms. Secondary phenomena, in the other hand, involve depressive episodes. A psychotherapeutic intervention was carried out in five women on leave from work due to diagnosed fibromyalgia. The intervention consists of a psychoanalytic proposal, using mediation groups for listening and for the continence of conflicting and dynamic experiences of social isolation potentialized by the disease. Distant from the values attributed to efficient bodies, produced by work, they experience their absences as something pejorative. This position gave rise to anxiogenic experiences with depressive characteristics. The representation of affections in the space established by the group allowed a symbolic expression of suffering, the delimitation of situations that intensify pain and the report of bodily pain as "a rottenness of the body" that blocked the articulation of daily activities. By offering welcoming and affects resignification, the psychotherapeutic care contributed to maintain general health status, mitigating dissociative experiences and lead to reflections on forms of interdisciplinary care.(AU)

La fibromialgia se caracteriza por dolor muscular crónico que llega a una amplia gama de aparatos del cuerpo. La dolorosa experiencia de la fibromialgia consiste en una reducción de la capacidad funcional, trastornos del sueño y la pérdida de las relaciones personales. La etiología puede comprender fenómenos primarios y secundarios relacionados con las condiciones de dolor psicógeno. Los fenómenos primarios son investigados desde la proposición de los trastornos psicosomáticos y síntomas de conversión. Los fenómenos secundarios implican trastornos depresivos. Hemos llevado a cabo una intervención psicoterapéutica con cinco mujeres sin trabajo para el diagnóstico de la fibromialgia. Se utilizó la propuesta del Grupo de Psicoanálisis de audiencia de mediación y la continencia de experiencias conflictivas y dinámicas de aislamiento social potenciada por la enfermedad. Lejos de los valores asignados a los órganos eficientes producidos por el trabajo, estaban relacionados con la distancia como algo peyorativo. Esta posición dio experiencias ansiogénicas con características depresivas. La representación de los afectos en el espacio creado por el grupo permitió la expresión simbólica del sufrimiento, de la delimitación de las situaciones que se intensificó el dolor y la cuenta del dolor corporal como " un cuerpo en descomposición" de restricción de la articulación de las actividades cotidianas. Al ofrecer aceptación y reformular el afecto, la atención psicoterapéutica contribuyó al mantenimiento de la situación general de la salud, de ablandamiento que conduce a las experiencias disociativas y reflexiones sobre las formas de atención interdisciplinaria.(AU)

La fibromyalgie est une douleur musculaire qui touche une grande étendue du corps. Vivre avec la douleur de la fibromyalgie implique une réduction de les capacites fonctionnelles, les troubles du sommeil et la perte sur les relations personnelles. L'étiologie peut comprendre des phénomènes primaires et secondaires relatives aux conditions de douleur psychogène. Les phénomènes principaux sont étudiés à partir de la proposition de troubles psychosomatiques et les symptômes de conversion. Les phénomènes secondaires impliquant les troubles dépressifs. Nous avons effectué une intervention psychothérapeutique avec cinq femmes sans emploi pour le diagnostic de fibromyalgie. La proposition de groupe psychanalytique de l'audience de médiation et de la continence des expériences contradictoires et dynamiques de l'isolement social potentialisée par la maladie a été utilisé. Éloignés des valeurs attribuées aux organismes efficaces produites par le travail, étaient liés à la distance comme quelque chose de péjoratif. Cette position a donné expériences anxiogènes avec caractéristiques dépressives. La représentation de l'affect dans l'espace défini par le groupe a permis l'expression symbolique de la souffrance, de la délimitation des situations qui ont intensifié la douleur et la cause de la douleur physique comme «un corps en décomposition " qui empêche l'articulation des activités quotidiennes. Avec réception et retour d'affection, l'attention psychothérapeutique a contribué à maintenir l'image globale de la santé, l'adoucissement menant à des expériences de dissociation et de réflexions sur les formes de soins interdisciplinaires.(AU)

A fibromialgia e a manifestação de sofrimento psíquico / Fibromyalgia and the manifestation of mental suffering / Fibromialgia y la manifestación de sufrimiento psíquico / Fibromyalgie et la manifestation de la souffrance psychique

A fibromialgia se caracteriza por dor muscular crônica que atinge uma ampla extensão do aparato corporal. A vivência dolorosa na fibromialgia implica uma redução das capacidades funcionais, distúrbios do sono e prejuízos às relações de sociabilidade. A etiologia pode compreender fenômenos psicogênicos primários e secundários relacionados aos quadros álgicos. Os fenômenos primários são investigados a partir da proposição de afecções psicossomáticas e de sintomas conversivos. Já os fenômenos secundários envolvem quadros depressivos. Realizou-se uma intervenção psicoterapêutica com cinco mulheres afastadas do trabalho pelo diagnóstico de fibromialgia. Utilizou-se a proposta psicanalítica do grupo de mediação para a escuta e a continência das vivências conflituosas e dinâmicas de isolamento social potencializadas pelo adoecimento. Distanciadas dos valores atribuídos aos corpos eficientes produzidos pelo trabalho relacionavam-se com o afastamento como algo pejorativo. Este posicionamento proporcionava vivências ansiogênicas com características depressivas. A representação dos afetos no espaço estabelecido pelo grupo permitiu a expressão simbólica do sofrimento, a delimitação das situações que intensificavam as dores e o relato da dor corporal, como "uma podridão do corpo" que barrava a articulação das atividades cotidianas. Ao oferecer acolhimento e ressignificação aos afetos, a atenção psicoterapêutica contribuiu para a manutenção do quadro geral de saúde, amenizando vivências dissociativas e levando a reflexões sobre formas de atendimento interdisciplinar.

Fibromyalgia is characterized by chronic muscle pain that affects a wide extension of the body. Pain experiences in fibromyalgia imply a reduction of functional capacity, sleep disturbances and loss of social relations. Its etiology may include primary and secondary psychogenic phenomena related to pain. Primary phenomena are investigated from the proposition of psychosomatic disorders and hysteria symptoms. Secondary phenomena, in the other hand, involve depressive episodes. A psychotherapeutic intervention was carried out in five women on leave from work due to diagnosed fibromyalgia. The intervention consists of a psychoanalytic proposal, using mediation groups for listening and for the continence of conflicting and dynamic experiences of social isolation potentialized by the disease. Distant from the values attributed to efficient bodies, produced by work, they experience their absences as something pejorative. This position gave rise to anxiogenic experiences with depressive characteristics. The representation of affections in the space established by the group allowed a symbolic expression of suffering, the delimitation of situations that intensify pain and the report of bodily pain as "a rottenness of the body" that blocked the articulation of daily activities. By offering welcoming and affects resignification, the psychotherapeutic care contributed to maintain general health status, mitigating dissociative experiences and lead to reflections on forms of interdisciplinary care.

La fibromialgia se caracteriza por dolor muscular crónico que llega a una amplia gama de aparatos del cuerpo. La dolorosa experiencia de la fibromialgia consiste en una reducción de la capacidad funcional, trastornos del sueño y la pérdida de las relaciones personales. La etiología puede comprender fenómenos primarios y secundarios relacionados con las condiciones de dolor psicógeno. Los fenómenos primarios son investigados desde la proposición de los trastornos psicosomáticos y síntomas de conversión. Los fenómenos secundarios implican trastornos depresivos. Hemos llevado a cabo una intervención psicoterapéutica con cinco mujeres sin trabajo para el diagnóstico de la fibromialgia. Se utilizó la propuesta del Grupo de Psicoanálisis de audiencia de mediación y la continencia de experiencias conflictivas y dinámicas de aislamiento social potenciada por la enfermedad. Lejos de los valores asignados a los órganos eficientes producidos por el trabajo, estaban relacionados con la distancia como algo peyorativo. Esta posición dio experiencias ansiogénicas con características depresivas. La representación de los afectos en el espacio creado por el grupo permitió la expresión simbólica del sufrimiento, de la delimitación de las situaciones que se intensificó el dolor y la cuenta del dolor corporal como " un cuerpo en descomposición" de restricción de la articulación de las actividades cotidianas. Al ofrecer aceptación y reformular el afecto, la atención psicoterapéutica contribuyó al mantenimiento de la situación general de la salud, de ablandamiento que conduce a las experiencias disociativas y reflexiones sobre las formas de atención interdisciplinaria.

La fibromyalgie est une douleur musculaire qui touche une grande étendue du corps. Vivre avec la douleur de la fibromyalgie implique une réduction de les capacites fonctionnelles, les troubles du sommeil et la perte sur les relations personnelles. L'étiologie peut comprendre des phénomènes primaires et secondaires relatives aux conditions de douleur psychogène. Les phénomènes principaux sont étudiés à partir de la proposition de troubles psychosomatiques et les symptômes de conversion. Les phénomènes secondaires impliquant les troubles dépressifs. Nous avons effectué une intervention psychothérapeutique avec cinq femmes sans emploi pour le diagnostic de fibromyalgie. La proposition de groupe psychanalytique de l'audience de médiation et de la continence des expériences contradictoires et dynamiques de l'isolement social potentialisée par la maladie a été utilisé. Éloignés des valeurs attribuées aux organismes efficaces produites par le travail, étaient liés à la distance comme quelque chose de péjoratif. Cette position a donné expériences anxiogènes avec caractéristiques dépressives. La représentation de l'affect dans l'espace défini par le groupe a permis l'expression symbolique de la souffrance, de la délimitation des situations qui ont intensifié la douleur et la cause de la douleur physique comme «un corps en décomposition " qui empêche l'articulation des activités quotidiennes. Avec réception et retour d'affection, l'attention psychothérapeutique a contribué à maintenir l'image globale de la santé, l'adoucissement menant à des expériences de dissociation et de réflexions sur les formes de soins interdisciplinaires.