O objetivo deste trabalho foi comparar aspectos clínicos de pacientes portadores de fibromialgia cujo início dos sintomas estivessem relacionados a eventos traumáticos e pacientes idiopáticos. Foram avaliados 135 pacientes por meio de um questionário estruturado sobre dados demográficos e situação de produtividade laboral, caracterização da dor e presença de queixas não relacionadas ao aparelho locomotor. Foi realizada contagem e dolorimetria de pressão dos pontos dolorosos e avaliação da dor segundo a escala visual analógica. O grupo de pacientes traumáticos conteve 48 pessoas apresentou maior período médio de escolaridade (8,1 &#177; 4,1 x 5,3 &#177; 2,9; p<0,001), maior contagem de pontos dolorosos (16,1 &#177; 2,8 x 15,0 &#177; 3,2; p = 0,047), menor período desde a generalização da dor (5,6 &#117; 6,9 x 4,1 &#177; 2,6 anos; p = 0,002) e maiores prevalências de dificuldade de concentração (83,0% x 65,1%; p = 0,048) e cólicas intestinais (45,8% x 26,4%; p = 0,036). Houve associação entre o trauma e a improdutividade econômica. Os demais aspetos clínicos não apresentaram diferença estatisticamente significante. Conclui-se que a etiologia traumática impõe poucas diferenças clínicas aos pacientes portadores de fibromialgia e não explicam o grau de incapacidade laboral que se observa. / The aim of this work was to compare clinical aspects of fibromyalgia patients whose onset was related to traumatic events to idiopathic patients. One hundred and thirty fice consecutive patients were interviewed with a structured questionnaire about demographic aspects, work disability, pain characterization and the presence of symptoms not related to the locomotor system. Tender point count and dolorimetry were performed, as well as pain evaluation according to the visual analogue scale. The group of traumatic patients counted with 48 individuals, and presented with longer period of formal education (8,1 &#117; 4,1 x 5,3 &#117; 2,9 years; p < 0,001), higher count of tender points (16,1 &#117; 2,8 x &#117; 3,2; p = 0,047), shorter period since generalization of pain (5,6 &#117; 6,9 x 4,1 &#117; 2,6 years; p = 0,002), smaller prevalences of concentration difficulties (83,0% x 65,1%; p = 0,048) and abdominal cramps(45,8% x 26,4%; p = 0,036). There was an association between trauma and work disability. Any of remaining clinical aspects presented with statistically significant differences. We conclude that trauma imposes few clinical differences to fibromyalgia patients and does not explain the degree of work disability which is observed among them.

Cette thèse propose d’interroger un dispositif de groupe thérapeutique à médiation sensorielle olfactive. Il a été créé comme une modalité d’accueil et d’écoute de sujets criminels, rencontrés dans le cadre d’une pratique en service psychiatrique en milieu carcéral. Ce dispositif innovant se fonde sur le besoin de créativité suscité par la confrontation avec une forme de clinique de l’extrême. Le choix de l’olfaction, comme modalité de contact, ouvre un champ de réflexion original, au carrefour de la philosophie, de la psychologie développementale, des neurosciences et de la psychanalyse. La notion « d’acte-sentir » est une proposition de modélisation des processus en jeu au contact du médium sensoriel olfactif. Proposé dans des pratiques groupales ou individuelles, le médium sensoriel olfactif favorise l’émergence de formes primaires de symbolisation, considérées comme des traces d’une subjectivité en déroute. Cette écoute du langage sensori-moteur et de ses formes particulières, suscitées par la mobilisation de l’odorat, est une proposition d’un abord psychothérapeutique de sujets aux prises avec des souffrances inexprimables voire insoutenables, engageant le clinicien « corps et âme ». / This thesis questions an innovative group setting, using an olfactive medium. It was started to meet and to listen to criminal patients in a psychiatric ward in prison. This new practice relys on the need to invent a way to react to the extreme seriousness of the mental illnesses in this ward. The choice of smell, as mean to get in touch, opens a wide field of reflections at the cross roads of philosophy, developmental psychology, neurosciences and psychoanalytical theory. “L’acte-sentir” the sensing-act is a proposal to pattern the different processes linked to smell as a medium. This work fits in groups or individual set-ups. Primary forms of symbolization appear with this medium, and illustrate a lost subjectivity. Listening to these words and helping associative work, is therapeutic with these suffering patients, who cannot speak easily. This work request a full body and mind implication. Use of the sens of smell to attempt to make sens to nonsense.