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Psychotherapie von Patienten mit Fibromyalgiesyndrom

Systematische Übersicht, Metaanalyse und Leitlinie

Psychotherapy for patients with fibromyalgia syndrome

Systematic review, meta-analysis and guideline

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Zusammenfassung

Hintergrund

Die planmäßige Aktualisierung der S3-Leitlinie zum Fibromyalgiesyndrom (FMS; AWMF-Registernummer 041/004) wurde ab März 2011 vorgenommen.

Material und Methoden

Die Leitlinie wurde unter Koordination der Deutschen Interdisziplinären Vereinigung für Schmerztherapie (DIVS) von 9 wissenschaftlichen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 50 Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt.

Die Literaturrecherche erfolgte über die Datenbanken Medline, PsycInfo, Scopus und Cochrane Library (bis Dezember 2010). Die Graduierung der Evidenzstärke erfolgte nach dem Schema des Oxford Center for Evidence Based Medicine. Grundlage der Empfehlungen waren die Evidenzstärke, die Wirksamkeit (Metaanalyse der Zielvariablen Schmerz, Schlaf, Müdigkeit und gesundheitsbezogene Lebensqualität), die Akzeptanz (Abbruchrate in Studien), Risiken (Nebenwirkungen) und die Anwendbarkeit der Therapieverfahren im deutschen Gesundheitssystem. Die Formulierung und Graduierung der Empfehlungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Die Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften begutachtet.

Ergebnisse und Schlussfolgerung

Kognitive Verhaltenstherapie in Kombination mit Ausdauertraining (multimodale Therapie) wird stark empfohlen. Entspannungstraining als Monotherapie soll nicht eingesetzt werden.

Abstract

Background

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften”, AWMF; registration number 041/004) was planned starting in March 2011.

Materials and methods

The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy (“Deutsche Interdisziplinären Vereinigung für Schmerztherapie”, DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields.

Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.

Results and conclusion

Cognitive behavioral therapy combined with aerobic exercise (multicomponent therapy) is strongly recommended. Relaxation as single therapy should not be applied.

The English full-text version of this article is available at SpringerLink (under “Supplemental”).

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Interessenkonflikt

Siehe Tab. 5 im Beitrag „Methodenreport“ von W. Häuser, K. Bernardy, H. Wang, I. Kopp in dieser Ausgabe

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Authors and Affiliations

  1. Fachklinik für Psychosomatische Medizin, MediClin Bliestal Kliniken, Am Spitzenberg, 66440, Blieskastel, Deutschland

    V. Köllner

  2. Medizinische Fakultät der Universität des Saarlandes, Homburg (Saar), Deutschland

    V. Köllner

  3. Innere Medizin 1, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland

    W. Häuser

  4. Interdisziplinäres Schmerzzentrum, Fachklinik Enzensberg, Hopfen am See, Deutschland

    K. Klimczyk

  5. Schmerzzentrum Zweibrücken, Zweibrücken, Deutschland

    H. Kühn-Becker

  6. Deutsche Fibromyalgie-Vereinigung, Seckach, Deutschland

    M. Settan

  7. Klinik für Physikalische Medizin und Rehabilitation, Klinikum Großhadern München, München, Deutschland

    M. Weigl

  8. Abteilung für Schmerzmedizin, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr-Universität Bochum, Bochum, Deutschland

    K. Bernardy

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  1. V. Köllner
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  2. W. Häuser
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Correspondence to V. Köllner.

Additional information

Die englische Volltextversion dieses Beitrags und der Evidenzbericht sind in SpringerLink zugänglich (unter „Supplemental“).

Zusatzmaterial online

English version of "Psychotherapie von Patienten mit Fibromyalgiesyndrom" (PDF 0,3 MB)

482_2012_1179_MO2_ESM.pdf

Evidenzbericht: Forest Plots der standardisierten Mittelwertdifferenzen von experimenteller Gruppe versus Kontrollgruppe bei ausgewählten Zielvariablen am Therapieende und bei Nachuntersuchungen (PDF 0,4 MB)

482_2012_1179_MO3_ESM.pdf

Evidence report: Forest Plots of standardised mean differences between experimental groups versus controls on selected outcomes at final treatment and at follow up (PDF 0,4 MB)

482_2012_1179_MO4_ESM.pdf

Evidenzbericht: Tabellen - Charakteristiken der Studien, die in qualitative und/oder quantitative Analyse einbezogen wurden (PDF 0,3 MB)

482_2012_1179_MO5_ESM.pdf

Evidence report: Tables - Characteristics of studies included into qualitative and/or quantitative analysis (PDF 0,7 MB)

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Köllner, V., Häuser, W., Klimczyk, K. et al. Psychotherapie von Patienten mit Fibromyalgiesyndrom. Schmerz 26, 291–296 (2012). https://doi.org/10.1007/s00482-012-1179-8

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