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”).
Literatur
Ali A, Njike VY, Northrup V et al (2009) Intravenous micronutrient therapy (Myers‘ Cocktail) for fibromyalgia: a placebo-controlled pilot study. J Altern Complement Med 15:247–257
Assefi NP, Sherman KJ, Jacobsen C (2005) A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med 143:10–19
Assefi N, Bogart A, Goldberg J, Buchwald D (2008) Reiki for the treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med 14:1115–1122
Astin JA, Berman BM, Bausell B et al (2003) The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol 30:2257–2262
Azad KAK, Alam MN, Haq SA et al (2000) Vegetarian diet in the treatment of fibromyalgia. Bangladesh Med Res Counc Bull 26:41–47
Baptista A (o J) Effectiveness of dance on patients with fibromyalgia. www.clinicaltrials.gov/ct2/show/NCT00961805?term( fibromyalgia+and+dance+therapy&rank(1
Bell IR, Lewis DA 2nd, Brooks AJ et al (2004) Individual differences in response to randomly assigned active individualized homeopathic and placebo treatment in fibromyalgia: implications of a double-blinded optional crossover design. J Altern Complement Med 10:123–131
Bell IR, Lewis DA 2nd, Brooks AJ et al (2004) Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology (Oxford) 43:577–582
Calandre EP, Rodriguez-Claro ML, Rico-Villademoros F et al (2009) Effects of pool-based exercise in fibromyalgia symptomatology and sleep quality: a prospective randomised comparison between stretching and Ai Chi. Clin Exp Rheumatol 27(5 Suppl 56):21–28
Cao H, Liu J, Lewith GT (2010) Traditional Chinese medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. J Altern Complement Med 16:397–409
Carson JW, Carson KM, Jones KD et al (2010) A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain 151:530–539
Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V (1990) Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 18:201–209
Chesky KS, Russell J, Lopez Y, Kondraske GV (1997) Fibromyalgia tender point pain: A double-blind, placebo-controlled pilot study of music vibration using the music vibration table (TM). J Musculoskelet Pain 5:33–52
Citera G, Arias MA, Maldonado-Cocco JA et al (2000) The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol 19:9–13
Colquhoun D (1990) Re-analysis of clinical trial of homoeopathic treatment in fibrositis. Lancet 336:441–442
Capili B, Anastasi JK, Geiger JN (2010) Adverse event reporting in acupuncture clinical trials focusing on pain. Clin J Pain 26:43–48
Silva GD da, Lorenzi-Filho G, Lage LV (2007) Effects of yoga and the addition of Tui Na in patients with fibromyalgia. J Altern Complement Med 13:1107–1113
Deluze C, Bosia L, Zirbs A et al (1992) Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 305:1249–1252
Denison B (2004) Touch the pain away: new research on therapeutic touch and persons with fibromyalgia syndrome. Holist Nurs Pract 18:142–151
Deuster PA, Jaffe RM (1998) A novel treatment for fibromyalgia improves clinical outcomes in a community-based study. J Musculoskelet Pain 6:133–149
Di Benedetto P, Iona LG, Zidarich V (1993) Clinical evaluation of S-adenosyl-methionine versus transcutaneous electrical nerve stimulation in primary fibromyalgia. Curr Ther Res 53:222–230
Edwards AM, Blackburn L, Christie S et al (2000) Food supplements in the treatment of primary fibromyalgia: a double-blind, crossover trial of anthocyanidins and placebo. J Nutr Environ Med 10:189–199
Fisher P (1986) An experimental double-blind clinical trial method in homeopathy. Use of a limited range of remedies to treat fibrositis. Br Homeopath J 75:142
Fisher P, Greenwood A, Huskisson EC et al (1989) Effect of homeopathic treatment on fibrositis (primary fibromyalgia). BMJ 299:365–366
Fontani G, Suman AL, Migliorini S et al (2010) Administration of omega-3 fatty acids reduces positive tender point count in chronic musculoskeletal pain patients. J Altern Complement Med 7. DOI 10.2202/1553–3840.1366
Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U (2007) Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom 76:226–233
Guo X, Jia J (2005) Comparison of therapeutic effects on fibromyalgia syndrome between dermal-neurological electric stimulation and electric acupuncture. Chinese J Rehabil 9:171–173 (Zielvariablen für Analyse nicht geeignet)
Haak T, Scott B (2008) The effect of Qigong on fibromyalgia (FMS): a controlled randomized study. Disabil Rehabil 30:625–633
Harris RE, Tian XT, Williams DA et al (2005) Treatment of fibromyalgia with formula acupuncture: Investigation of needle placement, needle stimulation and treatment frequency. J Altern Complement Med 11:663–671
Harris RE, Zubieta JK, Scott DJ et al (2009) Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 47:1077–1088
Holmer, Malinda L (2004) The effects of yoga on symptoms and psychosocial adjustment in fibromyalgia syndrome patients. Abstracts International: Section B: The Sciences and Engineering 65(5-B), 2630. (Dissertation; nur als Abstract vorliegend)
Horwitz EB, Kowalski J, Theorell T, Anderberg UM (2006) Dance/movement therapy in fibromyalgia patients: changes in self-figure drawings and their relation to verbal self-rating scales. Arts Psychother 33:11–25
Hussain SA, Al-Khalifa II, Jasim NA, Gorial FI (2010) Adjuvant use of melatonin for treatment of fibromyalgia. J Pineal Res. DOI 10.1111/j.1600–079X.2010.00836.x
Itoh K, Kitakoji H (2010) Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial. Chin Med 5:11
Jacobsen S, Danneskiold-Samsoe B, Andersen RB (1991) Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation. Scand J Rheumatol 20:294–302
Jang ZY, Li CD, Qiu L et al (2010) Combination of acupuncture, cupping and medicine for treatment of fibromyalgia syndrome: a multi-central randomized controlled trial. Zhongguo Zhen Jiu 30:265–269 (Kombination Akupunktur mit anderen Methoden)
Kaartinen K, Lammi K, Hypen M et al (2000) Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol 29:308–313
Kendall SA, Brolin-Magnusson K, Sören B et al (2000) A pilot study of body awareness programs in the treatment of fibromyalgia syndrome. Arthritis Care Res 13:304–311
Kendall SA, Ekselius L, Gerdle B et al (2001) Feldenkrais intervention in fibromyalgia patients: a pilot study. J Musculoskelet Pain 9:25–35
Langhorst J, Häuser W, Irnich D et al (2008) Komplementäre und alternative Therapien beim Fibromyalgiesyndrom. Schmerz 22:324–333
Lautenschläger J, Schnorrenberger CC, Müller W (1989) Acupuncture in generalized tendomyopathia (fibromyalgia syndrome). Dtsch Z Akupunkt 32:122–128 (Deutsch)
Mannerkorpi K, Arndorw M (2004) Efficacy and feasibility of a combination of body awareness therapy and qigong in patients with fibromyalgia: a pilot study. J Rehabil Med 36:279–281
Martin DP, Sletten CD, Williams BA, Berger H (2006) Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc 81:749–757
Merchant RE, Andre CA, Wise CM (2001) Nutritional supplementation with Chlorella pyrenoidosa for fibromyalgia syndrome: a double-blind, placebo-controlled, crossover study. J Musculoskelet Pain 9:37–54
Mueller-Busch HC, Hoffmann P (1997) Active music therapy for chronic pain: a prospective study [Aktive Musiktherapie bei chronischen Schmerzen. Eine prospektive Untersuchung] Schmerz 11:91–100
Relton C, Smith C, Raw J et al (2009) Healthcare provided by a homeopath as an adjunct to usual care for Fibromyalgia (FMS): results of a pilot randomised controlled trial. Homeopathy 98:77–82
Rossini M, Di Munno O, Valentini G et al (2007) Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol 25:182–188
Russell IJ, Michalek JE, Flechas JD, Abraham GE (1995) Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol 22:953–958
Sandberg M, Lundeberg T, Gerdle B (1999) Manual acupuncture in fibromyalgia: a long-term pilot study. J Musculoskelet Pain 7:39–51
Schmidt S, Grossman P, Schwarzer B et al (2011) Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain 152:361–369
Sephton SE, Salmon P, Weissbecker I et al (2007) Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. Arthritis Rheum 57:77–85
Stephens S, Feldman BM, Bradley N et al (2008) Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum 59:1399–1406
Sprott H (1998) Efficacy of acupuncture in patients with fibromyalgia. Clin Bull Myofascial Ther 3:37–43
Targino RA, Imamura M, Kaziyama HH et al (2008) A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med 40:582–588 (Kombination von Akupunktur mit Amitriptylin und multimodaler Therapie)
Tavoni A, Jeracitano G, Cirigliano G (1998) Evaluation of S-adenosylmethionine in secondary fibromyalgia: a double-blind study. Clin Exp Rheumatol 16:106–107
Tavoni A, Vitali C, Bombardieri S, Pasero G (1987) Evaluation of S-adenosylmethionine in primary fibromyalgia. A double-blind crossover study. Am J Med 83:107–110
Volkmann H, Norregaard J, Jacobsen S et al (1997) Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 26:206–211
Wahner-Roedler DL, Thompson JM, Luedtke CA et al (2008) Dietary soy supplement on fibromyalgia symptoms: a randomized, double-blind, placebo-controlled, early phase trial. Evid Based Complement Alternat Med 14(Suppl 1):25
Wang C, Schmid CH, Rones R et al (2010) A randomized trial of tai chi for fibromyalgia. N Engl J Med 363:743–754
Interessenkonflikt
Siehe Tab. 5 im Beitrag „Methodenreport“ von W. Häuser, K. Bernardy, H. Wang, I. Kopp in dieser Ausgabe
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Die englische Volltextversion dieses Beitrags und der Evidenzbericht sind in SpringerLink zugänglich (unter „Supplemental“).
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Evidenzbericht: Forest Plots der standardisierten Mittelwertdifferenzen von experimenteller Gruppe versus Kontrollgruppe bei ausgewählten Zielvariablen am Therapieende und bei Nachuntersuchungen (PDF 0,4 MB)
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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)
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Evidenzbericht: Tabellen - Charakteristiken der Studien, die in qualitative und/oder quantitative Analyse einbezogen wurden (PDF 0,3 MB)
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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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DOI: https://doi.org/10.1007/s00482-012-1178-9