Der Schmerz

, Volume 21, Issue 5, pp 424–429 | Cite as

Ein Modell zur Einteilung des Fibromyalgiesyndroms

  • W. Müller
  • M. Schneider
  • T. Joos
  • H.Y. Hsu
  • T. Stratz
Übersichten

Zusammenfassung

Nach Ansicht verschiedener Arbeitsgruppen stellt die Fibromyalgie keine Entität dar. Man unterscheidet diverse Untergruppen. Eine Gruppe zeichnet sich durch eine hohe Schmerzempfindlichkeit ohne begleitende psychische Störungen aus, während bei einer weiteren Gruppe Depressionen im Vordergrund stehen, zusätzlich wird eine sog. somatoforme Schmerzstörung vom Fibromyalgietyp diskutiert. In Gruppe 1 werden blande inflammatorische Prozesse, in Gruppe 2 Depressionen und in Gruppe 3 psychische Probleme mit einem insuffizienten Schmerzscoping als Ursache diskutiert.

Gruppe 1 profitiert von der Blockade der 5-HT3-Rezeptoren, Gruppe 2 von Antidepressiva und Gruppe 3 von einer Psychotherapie. Zusätzlich ist eine multimodale Therapie angebracht. Vor allem sog. Mischgruppen bedürfen einer Kombination der oben genannten Maßnahmen.

Schlüsselwörter

Fibromyalgie Untergruppen Therapie 5-HT3-Rezeptorantagonist Antidepressiva 

Subgroups of fibromyalgia

Abstract

As has been shown by a number of working groups, primary fibromyalgia syndrome does not represent a single clinical entity. It is possible to distinguish between a subgroup with high pain sensitivity and no associated psychiatric condition, a second subgroup characterized by depression and concomitant pain symptoms associated with fibromyalgia syndrome, and a third group with somatoform pain disorder of the fibromyalgia type. Bland inflammatory processes must be considered as the cause in the first group, while depression is the underlying reason for the development of pain in the second group. In the third group, serious previous or still existing psychological problems or also insufficient coping with illness symptoms must be regarded as the reason for pain chronification.

Group 1 benefits from a blocking of the 5-HT3 receptors by means of tropisetron, for example. This not only affects pain chronification but also the inflammatory process itself. Group 2 needs antidepressant treatment, whereas the focus should be on psychotherapy is group 3. Groups 1 and 2 will also profit from multimodal physical treatment programs; to a certain extent this applies to group 3 as well. So-called mixed types require a combination of therapeutic measures.

Keywords

Fibromyalgia Subgroups Therapy 5-HT3 receptor antagonist Antidepressant treatment 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • W. Müller
    • 1
  • M. Schneider
    • 2
  • T. Joos
    • 3
  • H.Y. Hsu
    • 3
  • T. Stratz
    • 1
    • 4
  1. 1.Rheumatologische Forschungsabteilung Park-Klinik Bad SäckingenBad SäckingenDeutschland
  2. 2.Klinik für Anästhesiologie Universität UlmUlmDeutschland
  3. 3.NMI Natural and Medical Sciences Institute, ReutlingenUniversität TübingenReutlingenDeutschland
  4. 4.Rheumaklinik Bad SäckingenBad SäckingenDeutschland

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