Psychopharmakotherapie bei generalisierter Tendomyopathie

  • R. Kocher
Conference paper


Soon after the introduction of major tranquilizers in 1951–1952, and antidepressants in 1957, the first publications on their analgesic, analgesia-economizing and analgesia-potentiating effect appeared. The psychopharmaca, particularly the antidepressants and major tranquilizers, were later used for all forms of chronic pain. Their mode of action has been explained by the positive influence on the central experience of pain: “reaching distance from pain” and “depersonalization of pain”. The antidepressants and neuroleptics interrupt or prevent the vicious circle: Pain → depression → anxiety → pain → etc., which occurs frequently in chronic pain. In addition, the following vicious circle can be interrupted: autonomous irritability → psychic reaction → pain → etc. There is some evidence that antidepressants reduce the transmission of pain impulses, also on a spinal level, by activation of the descending serotoninergic and noradrenergic pain-inhibiting pathways, here as the minor tranquilizers and other psychopharmaca dampen the “arousal reaction” in the reticular formation. The neuroleptics, in the processing of pain, are more likely to act on a cerebral level. For treatment of fibromyalgia the psychopharmaca are used successfully, particularly the antidepressants (clomipramine and maprotiline). We know that psychological factors like depression, anxiety, aggression, stress, and emotional disorders play a significant role.


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  1. 1.
    Antkiewicz-Michalik L, Rokosz-Pelc A, Ventrilani A (1984) Increase in rat cortical (3H-)Naloxone bindings site density after chronic administration of antidepressants agents. Eur J Pharmacol 102: 179–181CrossRefGoogle Scholar
  2. 2.
    Aschoff JC (1987) Neurotransmitter und Schmerz. In: Ciba-Geigy (Hrsg) Psychopharmaka bei chronischen Schmerzen. Workshop Mai 1987. Geigy Pharma, BaselGoogle Scholar
  3. 3.
    Balmer R, Battegay R, Labhardt F, Müller W (1978) Weichteilrheumatische Erkrankungen und Depression - ein Beitrag zur Psychopharmako- und Psychotherapie. Aktuel Rheumatol 3: 97–105Google Scholar
  4. 4.
    Bennett R, Gatter RA, Campbell SM, Clark SR, Scarola JA (1988) A comparison of cyclobenzaprine and placebo in the management of fibrositis. A double-blind controlled study. Arthritis - Rheum 31: 1535–1542Google Scholar
  5. 5.
    Bibolotti E, Borglei C, Pasculli E et al. (1986) The management of fibrositis: a double-blind comparison of maprotiline, chlorimipramine, and placebo. Clin Trial J 23: 269–280Google Scholar
  6. 6.
    Carette S, McCain GA, Bell DA, Fam AG (1986) Evaluation of amitriptyline in primary fibrositis. Arthritis Rheum 29: 655–659PubMedCrossRefGoogle Scholar
  7. 7.
    Caruso I, Sarzi-Puttini PC, Boccassini L et al. (1987) Double-blind study of dothiepin versus placebo in the treatment of fibromyag syndrome. J Int Med Res 15: 154–159PubMedGoogle Scholar
  8. 8.
    Delay J, Deniker P (1952) 38 cas de psychoses traitées par la cure prolongée et continue de 4560 R.P. Ann Med Psychol 110: 495–502Google Scholar
  9. 9.
    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
  10. 10.
    Gram LF (1977) Plasma level monitoring of tricyclic antidepressant therapy. Clin Pharmakokinet 2: 1011–1115Google Scholar
  11. 11.
    Hartmann EL (1973) The function of sleep. Yale University Press, New HavenGoogle Scholar
  12. 12.
    Hauri P, Hawkins DR (1973) Alpha-delta sleep. Electroencephalogr Clin Neurophysiol 34: 233–237PubMedCrossRefGoogle Scholar
  13. 13.
    Kocher R (1968) Zur Behandlung schwerer Schmerzzustände mit einer Kombination von Tofranil (Imipramin) und Nozinan (Levomepromazin). Schweiz Rundsch Med Praxis 57: 1459–1464Google Scholar
  14. 14.
    Kocher R (1989) Psychopharma in der Schmerzbehandlung. Schweiz Rundsch Med Praxis 14: 394–398Google Scholar
  15. 15.
    Kocher R, Ladewig D, Holsboer-Trachsler E (1990) Nachtschlafableitungen bei Patienten unter Methadon und bei chronischen Alkoholikern in der Abstinenzphase. 11. Frühjahrstagung der Schweiz. Gesellschaft für Klinische Neurophysiologie vom 8./9. Mai 1990 in Stein am RheinGoogle Scholar
  16. 16.
    Kuhn R (1957) Über die Behandlung depressiver Zustände mit einem Iminodibenzylderivat (G 22355). Schweiz Med Wochenschr 87: 1135–1140PubMedGoogle Scholar
  17. 17.
    Linke H (1963) Die Entpersönlichung des Schmerzes durch Phenothiazinderivate. Ther Ber 35: 94–99Google Scholar
  18. 18.
    Mayer DJ, Price DP (1976) Central nervous system mechanism of analgesia. Pain 2: 379–404PubMedCrossRefGoogle Scholar
  19. 19.
    Moldofsky H, Scarisbrick P, England R, Smythe H (1975) Musculoskeletal symptoms and non-REM sleep, disorder in patients with “fibrositis syndrome” and healthy subjects. Psychosom Med 37: 341–351PubMedGoogle Scholar
  20. 20.
    Moldofsky H, Scarisbrick P (1976) Induction of neurasthenic musculoskeletal pain syndrome by sleep stage deprivation. Psychosom Med 38: 35–44PubMedGoogle Scholar
  21. 21.
    Moldofsky H, Warsh JJ (1978) Plasma tryptophan and musculoskeletal pain in non-articular rheumatism (“fibrositis syndrome”). Pain 5: 65–71PubMedCrossRefGoogle Scholar
  22. 22.
    Moldofsky H, Lue FA (1980) The relationship of alpha and delta EEG frequencies to pain and mood in “fibrositis” patients treated with chlorpromazine and L-triptophan. Electroencephalogr Clin Neurophysiol 50: 71–80PubMedCrossRefGoogle Scholar
  23. 23.
    Moldofsky H (1989) Sleep and fibrositis syndrome. Rheum Dis Clin North Am 15: 91–103PubMedGoogle Scholar
  24. 24.
    Müller W, Lautenschläger J (1990) Die generalisierte Tendomyopathie (GTM). Klinik, Verlauf und Differentialdiagnose, Pathogenese und Therapie. Z Rheumatol 49: 11–29Google Scholar
  25. 25.
    Paoli F, Darcourt G, Cossa P (1960) Note préliminaire sur l’action de l’imipramine dans les états douloureux. Rev Neurol 102: 503–504PubMedGoogle Scholar
  26. 26.
    Pöldinger W (1991) Psychosomatische Aspekte aus psychophysiologischer Sicht. Symposium 28. –30. Juni 1990. Generalisierte Tendomyopathie (Fibromyalgie) (im Druck)Google Scholar
  27. 27.
    Sigwald J, Hébert HH, Quetin A (1957) Traitement du zona et des algies zostérienes (ainsi que de certaines algies rebelles) par les phénothiazines. Sem Hôp (Paris) 33: 1137–1139Google Scholar
  28. 28.
    Spencer PSJ (1976) Some aspects of pharmacology of analgesia. J Int Med Res 4: 1–14PubMedGoogle Scholar
  29. 29.
    Takagi H (1980) The nucleus reticularis paragiganto-cellularis as a site of analgesic-action of morphine and enkephalin. Trends Pharmacol Sci 1: 182–184CrossRefGoogle Scholar
  30. 30.
    Vogel GW (1968) REM deprivation III. Dreaming and psychosis. Arch Gen Psychiatry 18: 312–329PubMedCrossRefGoogle Scholar
  31. 31.
    Wysenbeek AJ, Mor F, Luric Y, Weinberger A (1985) Imipramine for treatment of fibrositis: a therapeutic trial. Ann Rheum Dis 44: 752–753PubMedCrossRefGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1991

Authors and Affiliations

  • R. Kocher
    • 1
  1. 1.Psychiatrische Universitätsklinik BaselBaselSwitzerland

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