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Somatosensory Rehabilitation Network

MéthodeRééducation sensitive des douleurs neuropathiques

La méthode de rééducation sensitive diminue les douleurs neuropathiques depuis la peau partiellement engourdie ou hypersensible au toucher. Elle comprend plusieurs techniques, dont la rééducation de l’hyposensibilité qui a pour objectif d’améliorer la qualité de la sensibilité tactile cutanée, voire de la normaliser.

Cette rééducation passe notamment par l’évaluation régulière de la qualité de l’hypoesthésie tactile, illustrée par le seuil de perception à la pression (SPP).
Parfois, l’hypoesthésie n’est pas accessible, car la peau est recouverte d’un tacon douloureux. En médecine depuis 1979, il y a lieu de parler d'allodynie mécanique. La définition originale est de Merskey & Bogduk (1994):
"Douleur causée par un stimulus qui normalement ne produit pas de douleur" Traduction de Malenfant 1998. Lors de la première séance d’ergothérapie, en cherchant à réaliser le bilan diagnostique de lésions axonales, le test de discrimination de deux points statiques, est alors intestable.

Lorsque cette hypersensibilité au toucher est présente,elle est un frein à tout autre traitement physique, car tout contact direct au coeur de ce territoire hypersensible, s’il est en soi, sur le moment, encore supportable, ce contact entraîne un post-effet très douloureux de plusieurs heures, voire de plusieurs nuits sans repos. Cette hypersensibilité au toucher provient des lésions axonales des fibres a-beta largement myélinisées. Plus précisément, après une lésion nerveuse périphérique d'un nerf de la peau, un bourgeonnement aberrant prolifère dans la corne postérieure de la moëlle épinière et expliquerait qu’un stimulus non nociceptif soit perçu de manière nociceptive (hypersensibilité au toucher). Ce mécanisme est un des modèles explicatifs des différents mécanismes de sensibilisation centrale. La méthode de rééducation sensitive des douleurs permet de renverser, petit à petit, ces mécanismes de sensitization, même de nombreuses années après l'apparition des douleurs neuropathiques provoquées.

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Douleurs neuropathiques - Interview

 

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Brocha Z STERN

Brocha Z STERN
PhD, OTR, CHT

Tome 18, Volume 2
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Luana COLLOCA

Luana COLLOCA
MD, PhD, MS

Tome 18, Volume 1
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