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Fibromyalgie — Ein Update

Fibromyalgia — An update

  • Schwerpunkt: Muskelschmerz aus internistischer Sicht
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Zusammenfassung

Die Fibromyalgie ist ein häufig auftretendes Syndrom bisher ungeklärter Ätiologie, das durch ausgedehnte chronische Schmerzen an den Bewegungsorganen mit zahlreichen funktionellen und vegetativen Beschwerden sowie oft psychischer Co-Morbidität gekennzeichnet ist. Die Erkrankung wird durch den Nachweis druckschmerzhafter „tender points“ nach den Klassifikationskriterien des American College of Rheumatology definiert. Aufgrund fehlender Labor- und bildgebender Befunde ist die Diagnose immer eine Ausschlussdiagnose. In den letzten Jahren haben sich zunehmend Hinweise für eine zentrale Schmerzerkrankung ergeben, bei der Stress, Traumen v. a. in der Kindheit sowie endokrinologische und genetische Faktoren eine Rolle spielen, während sich peripher keine eindeutig pathologischen Befunde nachweisen lassen. Ansatzpunkte der Therapie sind vor allem Schmerzen, Funktionsstörungen infolge verminderter Muskelkraft und Schlafstörungen. In zahlreichen kontrollierten Studien konnten sowohl Pharmaka als auch nichtmedikamentöse Behandlungen mit hoher Evidenz als wirksam identifiziert werden. Zu diesen zählen die trizyklischen Antidepressiva sowie Fitnessprogramme, Patientenschulungen und Verhaltenstherapie einschließlich Kombinationen dieser Therapien.

Abstract

Fibromyalgia is a common syndrome of unknown etiology characterized by chronic widespread pain and polysymptomatic autonomic disturbances and often mental features. The American College of Rheumatology’s classification criteria define fibromyalgia by widespread pain and 11 of 18 tender points. Fibromyalgia is a diagnosis of exclusion as long as stand none laboratory or technical tests. The major role in pathogenesis appears to be central and involves the subcortical pain modulation, psychical stress especially in early childhood, endocrinological and genetic factors. There is no evidence of abnormalities in muscle and tendon. The goal of therapy in fibromyalgia is pain, reduced physical function and sleep disturbance. Actual evidence of effects of pharmacological and nonpharmacological interventions are summarized. Tricyclic agents, aerobic exercises, patient education and combined therapies can reduce effectively symptoms and disability.

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Brückle, W., Zeidler, H. Fibromyalgie — Ein Update. Internist 46, 1188–1197 (2005). https://doi.org/10.1007/s00108-005-1497-3

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