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Medikamentöse Therapie des Fibromyalgiesyndroms

Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten

Drug therapy of fibromyalgia syndrome

Updated guidelines 2017 and overview of systematic review articles

Zusammenfassung

Hintergrund

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

Material und Methoden

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 nach systematischen Übersichtsarbeiten von randomisierten, kontrollierten Medikamentenstudien erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke erfolgte nach dem Schema des Oxford Centre for Evidence-Based Medicine, Version 2009. Die Formulierung und Graduierung der Empfehlungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Wirksamkeit, Risiken, Patientinnenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.

Ergebnisse und Schlussfolgerung

Amitriptylin, Duloxetin bei komorbiden depressiven Störungen oder generalisierter Angststörung und Pregabalin bei komorbider generalisierter Angststörung werden empfohlen. Der Off-label-Gebrauch von Duloxetin oder Pregabalin kann im Falle von fehlenden komorbiden depressiven Störungen oder fehlender generalisierter Angststörung erwogen werden. Starke Opioide werden nicht empfohlen.

Abstract

Background

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled 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 literature search for systematic reviews of randomized controlled drug trials from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines.

Results and conclusion

Amitriptyline and duloxetine are recommended in the case of comorbid depressive disorders or generalized anxiety disorder and pregabalin in the case of generalized anxiety disorder. Off-label use of duloxetine and pregabalin can be considered if there are no comorbid mental disorders or no generalized anxiety disorder. Strong opioids are not recommended.

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Corresponding author

Correspondence to C. Sommer.

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Interessenkonflikt

Die Interessenkonflikte sind im Leitlinienreport [18] aufgeführt.

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

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Sommer, C., Alten, R., Bär, KJ. et al. Medikamentöse Therapie des Fibromyalgiesyndroms. Schmerz 31, 274–284 (2017). https://doi.org/10.1007/s00482-017-0207-0

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Schlüsselwörter

  • Fibromyalgiesyndrom
  • Systematische Übersicht
  • Leitlinie
  • Medikamentöse Therapie
  • Evidenzbasierte Medizin

Keywords

  • Fibromyalgia syndrome
  • Review, systematic
  • Guidelines
  • Drug therapy
  • Medicine, evidence-based