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Klinik, Pathophysiologie und Therapie des Fibromyalgiesyndroms

Clinical features, pathophysiology and treatment of fibromyalgia

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Abstract

In rheumatology, all of the more than 400 specified syndromes are associated with pain. In the conceptual discussion on the multidimensional influences postulated to explain the development of chronic pain, fibromyalgia has gained increasing interest. Fibromyalgia (fibrositis) is an unspecific soft-tissue disorder with chronic wide-spread musculoskeletal pain and palpable hypersensitivity at fibrositic tender points. Fibromyalgia is often associated with fatigue, nonrestorative sleep and other symptoms. The syndrome has a high prevalence in women, but in most cases it has a long course with unsatisfactory attempts at therapy before the diagnosis is made. Though diagnostic criteria have been defined to describe it as a distinct clinical syndrome, speculations on its aetiology and pathogenetic mechanisms are still controversial. Histochemical investigations on muscle biopsy and biochemical tests have revealed unspecific changes but no characteristic muscle abnormality. It is supposed that the clinical features may result from central neurohumoral dysfunction combining with peripheral mechanisms to result in hyperalgesia. An integrated therapeutic concept with a reassuring and positive doctor-patient relationship can be helpful in achieving satisfactory treatment results.

Zusammenfassung

Das Fibromyalgiesyndrom ist ein zu den unspezifischen, weichteilrheumatischen Erkrankungen zählendes, chronisches Schmerzsyndrom, für das inzwischen eindeutige diagnostische Kriterien festgelegt wurden. Das vorwiegend bei Frauen vorkommende Krankheitsbild ist durch Muskelschmerzen in mehreren Körperregionen, eine charakteristische Überempfindlichkeit definierter muskulärer Druckpunkte, Müdigkeit, Schlafstörungen und weitere Begleitsymptome gekennzeichnet. Die auch unter der Bezeichnung Fibrositis, generalisierte Tendomyopathie und anderen Namen bekannten klinischen Phänomene haben zu kontroversen Spekulationen über Ätiologie und Pathogenese geführt. Histologische und biochemische Untersuchungen von Muskelbiopsien zeigen unspezifische Veränderungen, die auf hypoxische Mikrotraumen der Muskulatur hinweisen. Das Fibromyalgiesyndrom ist dennoch keine primär muskuläre Erkrankung, sondern wahrscheinlich Ausdruck einer zentralen neurohumoralen Dysfunktion, durch die es—auch in Verbindung mit peripheren Mechanismen—zu einer Hypervigilanz bzw.,-algesie im Bereich der an nozizeptorreichen Muskeln und Sehnenansätzen lokalisierten Druckpunkte kommt. Der meist langjährige Verlauf wird durch die Intensität der Schmerzen, die Müdigkeit und Leistungseinschränkung, weniger durch physische Behinderungen bestimmt. Die vielfältigen klinischen Erscheinungen müssen in einem integrierten therapeutischen Behandlungskonzept berücksichtigt werden, in dem eine vertrauensvolle Arzt-Patienten-Beziehung besonders bedeutsam ist.

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  1. Abteilung für Anästhesie und Schmerztherapie am Gemeinschaftskrankenhaus Herdecke, Universität Witten/Herdecke, Beckweg 4, D-58313, Herdecke

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Müller-Busch, H.C. Klinik, Pathophysiologie und Therapie des Fibromyalgiesyndroms. Schmerz 8, 133–145 (1994). https://doi.org/10.1007/BF02530390

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