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Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom

Systematische Übersicht, Metaanalyse und Leitlinie

Complementary and alternative therapies for 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

Meditative Bewegungstherapien (Qigong, Tai-Chi, Yoga) werden stark empfohlen. Die Therapie mit Akupunktur kann erwogen werden. Achtsamkeitsbasierte Stressreduktion als Monotherapie und Tanztherapie als Monotherapie werden nicht empfohlen. Homöopathie wird nicht empfohlen, wobei in einem Minderheitenvotum eine offene Empfehlung („kann erwogen werden“) favorisiert wurde. Nahrungsmittelergänzungsprodukte und Reiki werden nicht empfohlen.

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

Meditative movement therapies (qi gong, tai chi, yoga) are strongly recommended. Acupuncture can be considered. Mindfulness-based stress reduction as monotherapy and dance therapy as monotherapy are not recommended. Homeopathy is not recommended. In a minority vote, homeopathy was rated as “can be considered”. Nutritional supplements and reiki are not recommended.

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

Author information

Authors and Affiliations

  1. Innere Medizin V (Naturheilkunde und Integrative Medizin), Kliniken Essen-Mitte, Am Deimelsberg 34a, 45276, Essen, Deutschland

    J. Langhorst

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

    W. Häuser

  3. Abteilung für Schmerztherapie, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr-Universität Bochum, Bochum, Deutschland

    K. Bernardy

  4. Schmerzambulanz, Schlei-Klinikum/FKSL, Schleswig, Deutschland

    H. Lucius

  5. Deutsche Fibromyalgie-Vereinigung, Seckach, Deutschland

    M. Settan

  6. Klinik und Poliklinik für Physikalische Medizin und Rehabilitation, Klinikum der Universität München, München, Deutschland

    A. Winkelmann

  7. National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, University of Tromsø, Tromsø, Norwegen

    F. Musial

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Corresponding author

Correspondence to J. Langhorst.

Additional information

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

Zusatzmaterial online

English version of "Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom" (PDF 0,3 MB)

482_2012_1178_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_1178_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_1178_MO4_ESM.pdf

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

482_2012_1178_MO5_ESM.pdf

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

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Langhorst, J., Häuser, W., Bernardy, K. et al. Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom. Schmerz 26, 311–317 (2012). https://doi.org/10.1007/s00482-012-1178-9

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