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Ätiopathogenese und Pathophysiologie des Fibromyalgiesyndroms und chronischer Schmerzen in mehreren Körperregionen

Etiology and pathophysiology of fibromyalgia syndrome and chronic widespread pain

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Zusammenfassung

Ziel

Die Erstellung eines ersten systematischen Reviews zur Ätiopathogenese und Pathophysiologie des Fibromyalgiesyndroms (FMS) und chronischer Schmerzen in mehreren Körperregionen (engl. „chronic widespread pain“, CWP).

Methodik

Eine interdisziplinäre Leitlinie wurde in Kooperation von 10 medizinischen bzw. psychologischen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen erstellt. Eine Literatursuche über alle Übersichtsarbeiten zur Ätiopathogenese und Pathophysiologie des FMS und CWP wurde unter Benutzung der Cochrane Collaboration Reviews (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006) und Scopus (1980–12/2006) durchgeführt. Für die Vergabe von Evidenzklassen wurde das System des Oxford Centre for Evidence-Based Medicine verwendet. Ein Konsens über die Evidenzklassen erfolgte in einem mehrstufigen nominalen Gruppenprozess.

Ergebnisse

Das FMS tritt gehäuft in Familien auf. Physische und psychische Stressoren am Arbeitsplatz sind Risikofaktoren für die Entwicklung von CWP und FMS. Affektive Störungen sind Risikofaktoren für die Entwicklung und Aufrechterhaltung eines FMS. Operante Lernmechanismen und Sensitivierung sind Risikofaktoren für die Chronifizierung eines FMS (Evidenzgrad 2b). Verschiedene Faktoren sind mit der Pathophysiologie des FMS assoziiert, ohne dass die Ursache-Wirkungs-Relation geklärt ist. Dazu gehören Störungen der zentralen Schmerzverarbeitung, eine Hyporeaktivität der Hypothalamus-Hypophysen-Nebennierenachse, eine Störung des Wachstumhormonsystems, erhöhte systemische proinflammatorische und verminderte antiinflammatorische Zytokinprofile, Veränderungen des dopaminergen und serotonergen Systems.

Schlussfolgerung

Das FMS ist eine Endstrecke verschiedener ätiopathogenetischer Faktoren und pathophysiologischer Mechanismen.

Abstract

Objective

To write a systematic review on the etiology and pathophysiology of the fibromyalgia syndrome (FMS) and of chronic widespread pain (CWP).

Methods

An interdisciplinary level-3 guideline (i.e. systematic literature search and assessment, logic analysis, formal consensus procedure) for the diagnosis and therapy of FMS was created in cooperation with 10 medical and psychological societies and 2 patient self-help organizations. A literature search was performed covering all available review articles on the etiology and pathophysiology of FMS and CWP using the Cochrane Collaboration Reviews (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006), and Scopus (1980–12/2006). For the assignment of evidence classes the system of the Oxford Centre for Evidence-Based Medicine was applied. Consensus was achieved by a multi-step nominal group procedure.

Results

FMS aggregates in families (evidence level 2c). Physical and psychological stress at the workplace are risk factors for the development of CWP and FMS. Affective disorders are risk factors for the development and maintenance of FMS. Operant learning mechanisms and sensitization are risk factors for the chronification of FMS (evidence levels 2b). Several factors are associated with the pathophysiology of FMS, but the causal relationship is unclear. This includes alterations of central pain pathways, hyporeactivity of the hypothalamus-pituitary-adrenal axis, increased systemic pro-inflammatory and reduced anti-inflammatory cytokine profiles and disturbances in the dopaminergic and serotonergic systems.

Conclusions

FMS is the common final product of various etiological factors and pathophysiological mechanisms.

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  1. Neurologische Klinik, Universität Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    C. Sommer & N. Üçeyler

  2. Zentrum für Schmerztherapie, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland

    W. Häuser

  3. Klinik für Pädiatrie mit Schwerpunkt Pneumologie/Immunologie, Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin , Berlin, Deutschland

    K. Gerhold

  4. Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Dresden, Dresden, Deutschland

    P. Joraschky

  5. Schmerzambulanz, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum zu Köln, Köln, Deutschland

    F. Petzke

  6. Klinik für Neurologie, Klinikum rechts der Isar, TU München, München, Deutschland

    T. Tölle

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

    A. Winkelmann

  8. Zentralinstitut für Seelische Gesundheit, Mannheim, Mannheim, Deutschland

    K. Thieme

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Sommer, C., Häuser, W., Gerhold, K. et al. Ätiopathogenese und Pathophysiologie des Fibromyalgiesyndroms und chronischer Schmerzen in mehreren Körperregionen. Schmerz 22, 267–282 (2008). https://doi.org/10.1007/s00482-008-0672-6

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