Medikamentöse Therapie des Fibromyalgiesyndroms
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Zusammenfassung
Fragestellung
Eine interdisziplinäre Leitlinie zur Therapie des Fibromyalgiesyndroms (FMS) und chronischer Schmerzen in mehreren Körperregionen (engl. „chronic widespread pain“, CWP) wurde in Kooperation von 10 medizinischen bzw. psychologischen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen erstellt.
Methodik
Eine Literatursuche über alle kontrollierten Studien (engl. „randomized controlled trial“, RCT) zur medikamentösen Therapie des FMS bzw. von CWP 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
Die zeitlich befristete Verwendung von Amitriptylin erhielt den Empfehlungsgrad A. Den Empfehlungsgrad B für die zeitlich befristete Verwendung erhielten Fluoxetin und Duloxetin.
Schlussfolgerung
Die Empfehlungen zur medikamentösen Therapie des FMS werden durch die kurze Studiendauer sowie fehlende Untersuchungen nach Therapieende und zur Kosteneffektivität eingeschränkt.
Schlüsselwörter
Fibromyalgiesyndrom (FMS) Leitlinie Systematischer Review MedikamentePharmacological treatment of fibromyalgia syndrome
Abstract
Background
An interdisciplinary guideline for the treatment of fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) was developed in cooperation with ten German medical and psychological associations and two patients’ self-help organizations.
Methods
Using the Cochrane Collaboration Reviews (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006), and Scopus (1980–12/ 2006) a systematic literature search was performed, which included all randomised controlled trials (RCT) evaluating multicomponent therapy in FMS and CWP. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of recommendation was graded according to the German program for disease management guidelines. Consensus was achieved using a multi-step nominal group procedure.
Results
The short-term use of amitriptyline is strongly recommended (grade A) and the short-term use of fluoxetine und duloxetine is recommended (grade B).
Conclusions
The recommendations regarding pharmacological treatment of FMS are limited by the short duration of the RCT, the lack of follow-ups and absence of cost-effectiveness studies.
Keywords
Fibromyalgia syndrome (FMS) Guideline Systematic review Pharmacological treatmentNotes
Interessenkonflikt
Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.
Literatur
- 1.Anderberg UM, Marteinsdottir I, von Knorring L (2000) Citalopram in patients with fibromyalgia – a randomized, double-blind, placebo-controlled study. Eur J Pain 4: 27–35PubMedCrossRefGoogle Scholar
- 2.Arnold LM, Hess EV, Hudson JI et al. (2002) A randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia. Am J Med 112: 191–197PubMedCrossRefGoogle Scholar
- 3.Arnold LM, Keck PE jr, Welge JA (2000) Antidepressant treatment of fibromyalgia. A meta-analysis and review. Psychosomatics 41: 104–113PubMedCrossRefGoogle Scholar
- 4.Arnold LM, Lu Y, Crofford LJ et al. (2004) A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 50: 2974–2984PubMedCrossRefGoogle Scholar
- 5.Arnold LM, Rosen A, Pritchett YL et al. (2005) A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain 119: 5–15PubMedCrossRefGoogle Scholar
- 6.Ataoğlu S, Ataoğlu A, Erdoğan F et al. (1997) Comparison of paroxetine, amitriptyline in the treatment of fibromyalgia. Turk J Med Sci 27: 535–539Google Scholar
- 7.Backman E, Bengtsson A, Bengtsson M et al. (1988) Skeletal muscle function in primary fibromyalgia. Effect of regional sympathetic blockade with guanethidine. Acta Neurol Scand 77: 187–191PubMedCrossRefGoogle Scholar
- 8.Bengtsson M, Bengtsson A, Jorfeldt L (1989) Diagnostic epidural opioid blockade in primary fibromyalgia at rest and during exercise. Pain Clin 39: 171–180Google Scholar
- 9.Bennett RM, Clark SC, Walczyk J (1998) A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med 104: 227–231PubMedCrossRefGoogle Scholar
- 10.Bennett RM, Gatter RA, Campbell SM et al. (1988) A comparison of cyclobenzaprine and placebo in the management of fibrositis. A dou-ble-blind controlled study. Arthritis Rheum 31: 1535–1542PubMedCrossRefGoogle Scholar
- 11.Bennett RM, Jones J, Turk DC et al. (2007) An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord 8: 27PubMedCrossRefGoogle Scholar
- 12.Bennett RM, Kamin M, Karim R et al. (2003) Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med 114: 537–545PubMedCrossRefGoogle Scholar
- 13.Bennett RM, Schein J, Kosinski MR et al. (2005) Mpact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen. Arthritis Rheum 53: 519–527PubMedCrossRefGoogle Scholar
- 14.Bentsson A, Bengtsson M (1988) Regional sympathetic blockade in primary fibromyalgia. Pain Clin 33: 161–167Google Scholar
- 15.Bessette L, Carette S, Fosse A et al. (1998) A placebo controlled crossover trial of subcutaneous salmon calcitonin in the treatment of patients with fibromyalgia. Scand J Rheumatol 27: 112–116PubMedCrossRefGoogle Scholar
- 16.Biasi G, Manca S, Manganelli S et al. (1998) Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. Int J Clin Pharmacol Res 13–19Google Scholar
- 17.Bibolotti E, Borghi C, Pasculli E (1986) The management of fibrositis: a double-blind comparison of maprotiline (ludiomil), chlor-imipramine, and placebo. J Clin Trials 23: 269–280Google Scholar
- 18.Cantini F, Bellandi F, Niccoli L et al. (1994) Fluoxetin combined with cyclobenzaprine in the treatment of fibromyalgia. Minerva Med 85: 97–100PubMedGoogle Scholar
- 19.Çapaci K, Hepgüler S (2002) Comparison of the effect of amitriptyline and paroxetine in the treatment of fibromyalgia syndrome. Pain Clin 14: 223–228CrossRefGoogle Scholar
- 20.Carette S, Bell MJ, Reynolds WJ et al. (1994) Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. A randomized, double-blind clinical trial. Arthritis Rheum 37: 32–40PubMedCrossRefGoogle Scholar
- 21.Carette S, McCain GA, Bell DA et al. (1986) Evaluation of amitriptyline in primary fibrositis. A double-blind, placebo-controlled study. Arthritis Rheum 29: 655–659PubMedCrossRefGoogle Scholar
- 22.Carette S, Oakson G, Guimont C et al. (1995) Sleep electroencephalography and the clinical response to amitriptyline in patients with fibromyalgia. Arthritis Rheum 38: 1211–1217PubMedCrossRefGoogle Scholar
- 23.Clark S, Tindall E, Bennett RM (1985) A double blind crossover trial of prednisone versus placebo in the treatment of fibrositis. J Rheumatol 12: 980–983PubMedGoogle Scholar
- 24.Crofford LJ, Rowbotham MC, Mease PJ et al. (2005) Pregabalin 1008–105 Study Group. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 52: 1264–1273PubMedCrossRefGoogle Scholar
- 25.Drewes HM (1991) Zopiclone in the treatment of sleep abnormalities in fibromyalgia. Scand J Rheumatol 20: 288–293PubMedCrossRefGoogle Scholar
- 26.Dwight MM, Arnold LM, O’Brien H et al. (1998) An open clinical trial of venlafaxine treatment of fibromyalgia. Psychosomatics 39: 14–17PubMedGoogle Scholar
- 27.Färber L, Stratz TH, Bruckle W et al. (2001) German Fibromyalgia Study Group. Short-term treatment of primary fibromyalgia with the 5-HT3-receptor antagonist tropisetron. Results of a randomized, double-blind, placebo-controlled multicenter trial in 418 patients. Int J Clin Pharmacol Res 21: 1–13PubMedGoogle Scholar
- 28.Finckh A, Berner IC, Aubry-Rozier B et al. (2005) A randomized controlled trial of de-hydroepiandrosterone in postmenopausal women with fibromyalgia. J Rheumatol 32: 1336–1340PubMedGoogle Scholar
- 29.Freedenfeld RN, Murray M, Fuchs PN et al. (2006) Decreased pain and improved quality of life in fibromyalgia patients treated with olanzapine, an atypical neuroleptic. Pain Pract 6: 112–118PubMedGoogle Scholar
- 30.Gendreau RM, Thorn MD, Gendreau JF et al. (2005) Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol 32: 1975–1985PubMedGoogle Scholar
- 31.Ginsberg F, Joos E, Geczy J et al. (1998) A pilot randomized placebo-controlled study of pirlindole in the treatment of primary fibromyalgia. J Musculoskel Pain 6: 6–17CrossRefGoogle Scholar
- 32.Ginsberg F, Mancaux A, Joos E et al. (1996) A randomized placebo-controlled trial of sustained-release amitriptyline in primary fibromyalgia. J Musculoskel Pain 4: 37–47CrossRefGoogle Scholar
- 33.Giordano N, Geraci S, Santacroce C et al. (1999) Efficacy and tolerability of paroxetine in patients with fibromyalgia syndrome: a single-blind study. Curr Ther Res 60: 696–702CrossRefGoogle Scholar
- 34.Goldenberg D, Mayskiy M, Mossey C et al. (1996) A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum 39: 1852–1859PubMedCrossRefGoogle Scholar
- 35.Goldenberg DL, Felson DT, Dinerman H (1986) A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 29: 1371–1377PubMedCrossRefGoogle Scholar
- 36.Gonzalez-Viejo MA, Avellanet M, Hernandez-Morcuende MI (2005) A comparative study of fibromyalgia treatment: ultrasonography and physiotherapy versus sertraline treatment. Ann Readapt Med Phys 48: 610–615PubMedGoogle Scholar
- 37.Gronblad M, Nykanen J, Konttinen Y et al. (1993) Effect of zopiclone on sleep quality, morning stiffness, widespread tenderness and pain and general dis-comfort in primary fibromyalgia patients. A double-blind randomized trial. Clin Rheumatol 12: 186–191PubMedCrossRefGoogle Scholar
- 38.Gür A, Karakoç M, Nas K et al. (2002) Effects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: a single-blind, placebo-controlled trial. Rheumatol Int 22: 188–193PubMedCrossRefGoogle Scholar
- 39.Hannonen P, Malminiemi K, Yli-Kerttula U et al. (1998) A randomized, double-blind, placebo-controlled study of moclobemide and amitriptyline in the treatment of fibromyalgia in females without psychiatric disorder. Br J Rheumatol 37: 1279–1286PubMedCrossRefGoogle Scholar
- 40.Häuser W, Musial F, Kopp I et al. (2008) Methodische Grundlagen für die Entwicklung der Leitlinienempfehlungen (Methodenreport). Schmerz, im DruckGoogle Scholar
- 41.Häuser W, Wilhelm R, Klein W et al. (2006) Subjektive Krankheitsattributionen und Inanspruchnahme medizinischer Leistungen von Patienten mit Fibromyalgiesyndrom. Schmerz 20: 119–127PubMedCrossRefGoogle Scholar
- 42.Heymann RE, Helfenstein M, Feldman D (2001) A double-blind, randomized, controlled study of amitriptyline, nortriptyline and placebo in patients with fibromyalgia. An analysis of outcome measures. Clin Exp Rheumatol 19: 697–702PubMedGoogle Scholar
- 43.Holman AJ, Myers RR (2005) A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum 52: 2495–2505PubMedCrossRefGoogle Scholar
- 44.Hrycaj P, Stratz T, Mennet P et al. (1996) Pathogenetic aspects of responsiveness to ondansetron (5-hydroxytryptamine type 3 receptor antagonist) in patients with primary fibromyalgia syndrome – a preliminary study. J Rheumatol 23: 1418–1423PubMedGoogle Scholar
- 45.Isomeri R, Mikkelson M, Latikka P et al. (1993) Effects of amitriptyline and cardiovascukar fitness training on patients with primray fibromyalgia. J Musculoscelet Pain 253–260Google Scholar
- 46.Jacobsen S, Danneskiold-Samsoe B, Andersen RB (1991) Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation. Scand J Rheumatol 20: 294–302PubMedCrossRefGoogle Scholar
- 47.Jaeschke R, Adachi J, Guyatt G et al. (1991) Clinical usefulness of amitriptyline in fibromyalgia: the results of 23 N-of-1 randomized controlled trials. J Rheumatol 18: 447–451PubMedGoogle Scholar
- 48.Janzen VD, Scudds RA (1997) Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome. Laryngoscope 107: 1420–1422PubMedCrossRefGoogle Scholar
- 49.Kempenaers C, Simenon G, Vander Elst M et al. (1994) Effect of an antidiencephalon immune serum on pain and sleep in primary fibromyalgia. Neuropsychobiology 30: 66–72PubMedCrossRefGoogle Scholar
- 50.Kendall SA, Schaadt ML, Graff LB et al. (2004) No effect of antiviral (valacyclovir) treatment in fibromyalgia: a double blind, randomized study. J Rheumatol 31: 783–784PubMedGoogle Scholar
- 51.Kiser RS, Cohen HM, Freedenfeld RN et al. (2001) Olanzapine for the treatment of fibromyalgia symptoms. J Pain Symptom Manage 22: 704–708PubMedCrossRefGoogle Scholar
- 52.McCleane G (2000) Does intravenous lidocaine reduce fibromyalgia pain? A randomized, double-blind, placebo controlled cross-over study. Pain Clin 12: 181–185CrossRefGoogle Scholar
- 53.McKenzie R, O’Fallon A, Dale J et al. (1998) Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial. JAMA 280: 1061–1066PubMedCrossRefGoogle Scholar
- 54.Moldofsky H, Lue FA, Mously C et al. (1996) The effect of zolpidem in patients with fibromyalgia: a dose ranging, double blind, placebo con-trolled, modified crossover study. J Rheumatol 23: 529–533PubMedGoogle Scholar
- 55.Müller A, Hartmann M, Eich W (2000) Health care utilization in patients with fibromyalgia syndrome (FMS). Schmerz 14: 77–83PubMedCrossRefGoogle Scholar
- 56.Nagaoka S, Ohno M, Sekiguchi A (2004) An open-label clinical trial of milnacipran in fibromyalgia syndrome with co-morbid depressive symptoms. Psychiatry Clin Psycho 8: 47–51Google Scholar
- 57.Nørregaard J, Volkmann H, Danneskiold-Samsoe B (1995) A randomized controlled trial of citalopram in the treatment of fibromyalgia. Pain 61: 445–449PubMedCrossRefGoogle Scholar
- 58.O’Malley PG, Balden E, Tomkins G et al. (2000) Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med 15: 659–666CrossRefGoogle Scholar
- 59.Offenbaecher M, Waltz M, Schoeps P (2000) Validation of a German version of the Fibromyalgia Impact Questionnaire (FIQ-G). J Rheumatol 27: 1984–1988PubMedGoogle Scholar
- 60.Olin R, Klein R, Berg PA (1998) A randomised double-blind 16-week study of ritanserin in fibromyalgia syndrome: clinical outcome and analysis of autoantibodies to serotonin, gangliosides and phospholipids. Clin Rheumatol 17: 89–94PubMedCrossRefGoogle Scholar
- 61.Özerbil O, Okudan N, Gökbel H et al. (2006) Comparison of the effects of two antidepressants on exercise performance of the female patients with fibromyalgia. Clin Rheumatol 25: 495–497PubMedCrossRefGoogle Scholar
- 62.Pattrick M, Swannell A, Doherty M (1993) Chlormezanone in primary fibromyalgia syn-drome: a double blind placebo controlled study. Br J Rheumatol 32: 55–58PubMedCrossRefGoogle Scholar
- 63.Posner IA (1994) Treatment of fibromyalgia syndrome with intravenous lidocaine: a prospective, randomized pilot study. J Musculoskelet Pain 2: 55–65CrossRefGoogle Scholar
- 64.Quijada-Carrera J, Valenzuela-Castano A, Povedano-Gomez J et al. (1996) Comparison of tenoxicam and bromazepan in the treatment of fi-bromyalgia: a randomized, double-blind, placebo-controlled trial. Pain Pract 65: 221–225Google Scholar
- 65.Quimby LG, Gratwick GM, Whitney CD et al. (1989) A randomized trial of cyclobenzaprine for the treatment of fibromyalgia. J Rheumatol 19 [suppl]: 140–143Google Scholar
- 66.Raphael JH, Southall JL, Treharne GJ et al. (2002) Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome. BMC Musculoskelet Disord 3: 21PubMedCrossRefGoogle Scholar
- 67.Reynolds WJ, Moldofsky H, Saskin P et al. (1991) The effects of cyclobenzaprine on sleep physiology and symptoms in patients with fibromyalgia. J Rheumatol 18: 452–454PubMedGoogle Scholar
- 68.Rico-Villademoros F, Hidalgo J, Dominguez I et al. (2005) Atypical antipsychotics in the treatment of fibromyalgia: a case series with olanzapine. Prog Neuropsychopharmacol Biol Psychiatry 29: 161–164PubMedCrossRefGoogle Scholar
- 69.Robinson RL, Jones ML (2006) In search of pharmacoeconomic evaluations for fibromyalgia treatments: a review. Expert Opin Pharmacother 7: 1027–1039PubMedCrossRefGoogle Scholar
- 70.Russell IJ, Fletcher EM, Michalek JE et al. (1991) Related articles, treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebo-controlled study. Arthritis Rheum 34: 552–560PubMedCrossRefGoogle Scholar
- 71.Russell IJ, Kamin M, Bennett RM et al. (2000) Efficacy of tramadol in treatment of pain in fibromyalgia. J Clin Rheumatol 6: 250–257CrossRefPubMedGoogle Scholar
- 72.Samborski W, Lezanska-Szpera M, Rybakowski JK (2004) Open trial of mirtazapine in patients with fibromyalgia. Pharmacopsychiatry 37: 168–170PubMedCrossRefGoogle Scholar
- 73.Santandrea S, Montrone F, Sarzi-Puttini P et al. (1993) A double-blind crossover study of two cyclobenzaprine regimens in primary fibromyalgia syndrome. J Int Med Res 21: 74–80PubMedGoogle Scholar
- 74.Sayar K, Aksu G, Ak I et al. (2003) Venlafaxine treatment of fibromyalgia. Ann Pharmacother 37: 1561–1565PubMedCrossRefGoogle Scholar
- 75.Scharf MB, Baumann M, Berkowitz DV (2003) The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia. J Rheumatol 30: 1070–1074PubMedGoogle Scholar
- 76.Scudds RA, McCain GA, Rollman GB et al. (1989) Improvements in pain responsiveness in patients with fibrositis after successful treatment with amitriptyline. J Rheumatol 19 [suppl]: 98–103Google Scholar
- 77.Şencan S, Ak S, Karan A et al. (2004) A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome. J Back Musculoskelet Rehabil 17: 57–61Google Scholar
- 78.Sörensen J, Bengtsson A, Ahlner J et al. (1997) Related articles, Fibromyalgia – are there different mechanisms in the processing of pain? A double blind crossover comparison of analgesic drugs. J Rheumatol 24: 1615–1621PubMedGoogle Scholar
- 79.Sörensen J, Bengtsson A, Backman E et al. (1995) Pain analysis in patients with fibromyalgia. Effects of intravenous morphine, lidocaine, and ketamine. Scand J Rheumatol 24: 360–365PubMedCrossRefGoogle Scholar
- 80.Späth M, Stratz T, Neeck G et al. (2004) Related articles, efficacy and tolerability of intravenous tropisetron in the treatment of fibromyalgia. Scand J Rheumatol 33: 267–270PubMedCrossRefGoogle Scholar
- 81.Stoll LA (2000) Fibromyalgia symptoms relieved by flupirtine: an open-label case series. Psychosomatics 41: 371–372PubMedCrossRefGoogle Scholar
- 82.Tavoni A, Vitali C, Bombardieri S et al. (1987) Evaluation of S-adenosylmethionine in primary fibromyalgia. A double-blind crossover study. Am J Med 83: 107–110PubMedCrossRefGoogle Scholar
- 83.Tofferi JK, Jackson JL, O’Malley PG (2004) Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum 51: 9–13PubMedCrossRefGoogle Scholar
- 84.Üçeyler N, Häuser W, Sommer C (2008) A systematic review of the effectiveness of treatment with antidepressants in fibromyalgia syndrome. Arthritis Care Res, in pressGoogle Scholar
- 85.Vitton O, Gendreau M, Gendreau J et al. (2004) A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia. Hum Psychopharmacol 19(1): 27–35CrossRefGoogle Scholar
- 86.Wolfe F, Cathey MA, Hawley DJ (1994) A double-blind placebo controlled trial of fluoxetine in fibromyalgia. Scand J Rheumatol 23: 255–259PubMedCrossRefGoogle Scholar
- 87.Wörz R (1991) Flupirtin bei chronischen myofasziellen Schmerzzuständen. Fortschr Med 109: 158–160PubMedGoogle Scholar
- 88.Yavuzer G, Küçükdeveci A, Arasli T et al. (1998) Moclobemid treatment in primary fibromyalgia syndrome. Eur J Phys Med Rehabil 8: 35–38Google Scholar
- 89.Yunus MB, AT M, Aldağ JC (1989) Short term effects of ibuprofen in primary fibromyalgia syndrome: a double blind, placebo controlled trial. J Rheumatol 16: 527–532PubMedGoogle Scholar