Somatopsychosoziale Aspekte der generalisierten Tendomyopathie

Summary

The amount of tension in the muscular skeleton system is dependent on personality, physical constitution, longlasting recurrent or actual psychosomatic problems and learned behavior. Muscular tension becomes a coping mechanism to deal with somato-psychical and social difficulties. The literature shows possible biochemical correlations with states of depression, and also an impaired serotonin metabolism. However, not all patients suffer from depression. Further, a depressive, depressive-hypochondric state, and/or state of anxiety can be a consequence of fibromyalgia pain. Impaired non-REM sleep and a disturbed system of pain-modulation in the middle brain and brain stem, and a decreased tolerance of frustration, as well as frustrated aggression are assumed to be responsible for muscle contraction.

In about 90% of the patients with fibromyalgia, psychoneuroses of different kinds have been found in which an impaired self- as well as an insufficient body awareness (partly as a consequence of the lasting pain) nearly always play a role. There are also significantly more life events and more problems compared to patients with rheumatoid arthritis. Four different strategies exist for therapy:

• 1) administration of antidepressive drugs;

• 2) relaxation:

• a) using drug therapy with benzodiazepines or meprobamate;

• b) with passive or, preferably, active physical therapy, resulting in physical strengthening, and leading also to an improved self-confidence

• c) autogenic training.

• 3) antirheumatic drug (for pain relief);

• 4) cognitive psychotherapy, individual and/or group, with the aim of cognitive reorientation, and fostering adequate strategies to cope with pain and problems.