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Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom und chronischen Schmerzen in mehreren Körperregionen

Principles of treatment, coordination of medical care and patient education in fibromyalgia syndrome and chronic widespread pain

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Zusammenfassung

Hintergrund

Eine interdisziplinäre Leitlinie zur Therapie des Fibromyalgiesyndroms (FMS) wurde in Kooperation von 10 medizinischen bzw. psychologischen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen erstellt.

Methodik

Eine Literatursuche über alle kontrollierten Studien zur Patientenschulung des FMS wurde unter Benutzung der Cochrane Collaboration Reviews (1993–12/2006), Medline (1980–12/2006), PsychInfo (1966–12/2006) und Scopus (1980–12/2006) durchgeführt. Für die Vergabe von Evidenzklassen wurde das System des Oxford Centre for Evidence-Based Medicine verwendet. Für die Vergabe von Empfehlungsgraden wurde die Empfehlungsgraduierung der nationalen Versorgungsleitlinien verwendet. Die Erstellung der Empfehlungen erfolgte in einem mehrstufigen nominalen Gruppenprozess.

Ergebnisse

Den Empfehlungsgrad A erhielten die Patienteninformation bei Erstdiagnose und Empfehlungsgrad B die ärztliche patientenzentrierte Kommunikation. Ein abgestuftes Behandlungskonzept in Abhängigkeit vom Ausmaß der Adaptation an Beeinträchtigungen von Alltagsfunktionen sowie Ansprechen auf Therapiemaßnahmen erhielt den Empfehlungsgrad C.

Schlussfolgerung

Die Langzeitbetreuung von FMS-Patienten sollte Grundsätze der psychosomatischen Grundversorgung und der gemeinsamen Entscheidungsfindung bzgl. der Therapieoptionen beinhalten.

Abstract

Background

A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups.

Methods

A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993–12/2006), Medline (1980–12/2006), PsychInfo (1966–12/2006) and Scopus (1980–12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used.

Results

Patient’s information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C).

Conclusions

The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.

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Authors and Affiliations

  1. Institut für Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, 06112, Halle, Deutschland

    A. Klement & M. Herrmann

  2. Zentrum für Schmerztherapie, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland

    W. Häuser

  3. Rheumaklinik Bad Nenndorf, Bad Nenndorf, Deutschland

    W. Brückle

  4. Deutsche Rheuma-Liga, Bonn, Deutschland

    U. Eidmann

  5. Deutsche Fibromyalgie Vereinigung, Seckach, Deutschland

    E. Felde & M. Settan

  6. Praxis für Anästhesiologie, Spezielle Schmerztherapie und Psychotherapie, Zweibrücken, Deutschland

    H. Kühn-Becker

  7. Generation Research Program, Humanwissenschaftliches Zentrum, Bad Tölz, Ludwig-Maximilians-Universität München, Bad Tölz, Deutschland

    M. Offenbächer

  8. Sektion Schmerztherapie, Stiftung Orthopädische Universitätsklinik Heidelberg, Heidelberg, Deutschland

    M. Schiltenwolf

  9. Klinik für Psychosomatik, Ostalb-Klinikum Aalen, Aalen, Deutschland

    M. von Wachter

  10. Abteilung Innere Medizin II (Allgemeine Klinische und Psychosomatische Medizin), Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    W. Eich

  11. Institut für Allgemeinmedizin, Otto-von-Guericke-Universität, Magdeburg, Deutschland

    M. Herrmann

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  1. A. Klement
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Klement, A., Häuser, W., Brückle, W. et al. Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom und chronischen Schmerzen in mehreren Körperregionen. Schmerz 22, 283–294 (2008). https://doi.org/10.1007/s00482-008-0673-5

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