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Ätiologie und Pathophysiologie des Fibromyalgiesyndroms

Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten sowie eine Übersicht über Studien zur Kleinfaserpathologie bei Subgruppen des FMS

Etiology and pathophysiology of fibromyalgia syndrome

Updated guidelines 2017, overview of systematic review articles and overview of studies on small fiber neuropathy in FMS subgroups

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Zusammenfassung

Hintergrund

Die planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.

Methodik

Die Leitlinie wurde unter Koordination der Deutschen Schmerzgesellschaft von dreizehn Fachgesellschaften und zwei Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 42 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 (von Dezember 2010 bis Mai 2016). Es wurden prospektive bevölkerungsbasierte Studien und systematische Übersichten mit Metaanalysen von Fall-Kontroll-Studien für die Feststellungen berücksichtigt. Die Graduierung der Evidenzstärke erfolgte nach dem Schema des Oxford Centre for Evidence-Based Medicine, Version 2009. Die Formulierung der Feststellungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.

Ergebnisse

Die aktuelle Studienlage erlaubt keine eindeutigen Aussagen zur Ätiologie und Pathophysiologie des Fibromyalgiesyndroms (FMS). Das FMS kann mit entzündlich-rheumatischen Erkrankungen, Genpolymorphismen, Lebensstilfaktoren (Rauchen, Übergewicht, mangelnde körperliche Aktivität), körperlicher Misshandlung und sexuellem Missbrauch in Kindheit und Erwachsenenalter und depressiven Störungen assoziiert sein.

Schlussfolgerung

Das FMS ist wahrscheinlich die Endstrecke verschiedener ätiopathogenetischer Faktoren und pathophysiologischer Mechanismen.

Abstract

Background

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was planned for April 2017.

Methods

The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Prospective population-based studies and systematic reviews with meta-analyses of case control studies were taken into consideration for the statements. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The statements were generated by multiple step formalized procedures. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines.

Results

Current data do not enable identification of distinct factors in the etiology and pathophysiology of fibromyalgia syndrome. Fibromyalgia syndrome can be associated with inflammatory rheumatic diseases, gene polymorphisms, life style factors (e.g. smoking, obesity and lack of physical activity), depressive disorders as well as physical and sexual abuse in childhood and adulthood.

Conclusion

Fibromyalgia syndrome is most probably the end result of various pathogenetic factors and pathophysiological mechanisms.

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Author information

Authors and Affiliations

  1. Neurologische Klinik, Universitätsklinikum Würzburg, Würzburg, Deutschland

    N. Üçeyler & C. Sommer

  2. Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Münster, Münster, Deutschland

    M. Burgmer

  3. Medis Research GmbH, Bad Kissingen, Deutschland

    E. Friedel

  4. Psychosomatische und Psychoonkologische Tagesklinik, Universitätsklinikum Jena, Jena, Deutschland

    W. Greiner

  5. Schmerzmedizin, Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    F. Petzke

  6. Rheumazentrum Ruhrgebiet, Herne, Deutschland

    M. Sarholz

  7. Sektion konservative Orthopädie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    M. Schiltenwolf

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

    A. Winkelmann

  9. Innere Medizin I, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland

    W. Häuser

  10. Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, München, Deutschland

    W. Häuser

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  1. N. Üçeyler
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  2. M. Burgmer
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  3. E. Friedel
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  4. W. Greiner
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  5. F. Petzke
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  6. M. Sarholz
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  7. M. Schiltenwolf
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  8. A. Winkelmann
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  9. C. Sommer
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  10. W. Häuser
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Corresponding author

Correspondence to N. Üçeyler.

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Interessenkonflikt

Die Interessenkonflikte sind im Leitlinienreport [15] aufgeführt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Üçeyler, N., Burgmer, M., Friedel, E. et al. Ätiologie und Pathophysiologie des Fibromyalgiesyndroms. Schmerz 31, 239–245 (2017). https://doi.org/10.1007/s00482-017-0202-5

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