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Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des sogenannten Fibromyalgiesyndroms bei Kindern und Jugendlichen

Systematische Literaturübersicht und Leitlinie

Definition, diagnosis and therapy of chronic widespread pain and so-called fibromyalgia syndrome in children and adolescents

Systematic literature review and guideline

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Zusammenfassung

Hintergrund

Die planmäßige Aktualisierung der S3-Leitlinie zum Fibromyalgiesyndrom (FMS; AWMF-Registernummer 041/004) wurde ab März 2011 vorgenommen.

Material und Methoden

Die Leitlinie wurde unter Koordination der Deutschen Interdisziplinären Vereinigung für Schmerztherapie (DIVS) von 9 wissenschaftlichen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 50 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 (bis Dezember 2010). Die Graduierung der Evidenzstärke erfolgte nach dem Schema des Oxford Center for Evidence Based Medicine. Die Formulierung und Graduierung der Empfehlungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Die Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften begutachtet.

Ergebnisse und Schlussfolgerung

Die Diagnose eines juvenilen FMS (JFMS) wurde als wissenschaftlich nicht etabliert eingestuft. Beim sog. JFMS wird eine multidimensionale Diagnostik mit validierten Instrumenten gefordert. Die Therapie sollte multimodal erfolgen, bei starker schmerzbedingter Beeinträchtigung auch primär stationär.

Abstract

Background

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften”, AWMF; registration number 041/004) was planned starting in March 2011.

Materials and methods

The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy (“Deutsche Interdisziplinären Vereinigung für Schmerztherapie”, DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields.

Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.

Results and conclusion

The diagnosis FMS in children and adolescents is not established. In so-called juvenile FMS (JFMS) multidimensional diagnostics with validated measures should be performed. Multimodal therapy is warranted. In the case of severe pain-related disability, therapy should be primarily performed on an inpatient basis.

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Interessenkonflikt

Siehe Tab. 5 im Beitrag „Methodenreport“ von W. Häuser, K. Bernardy, H. Wang, I. Kopp in dieser Ausgabe

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Authors and Affiliations

  1. Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland

    B. Zernikow

  2. Vodafone Stiftungslehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Universität Witten/Herdecke, Witten, Deutschland

    B. Zernikow

  3. Universitätskinderklinik, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    K. Gerhold

  4. MVZ Kinder und Jugendliche Herne, Herne, Deutschland

    G. Bürk

  5. Innere Medizin 1, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland

    W. Häuser

  6. Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen, Deutschland

    C.H. Hinze, E. Schnöbel-Müller & R. Häfner

  7. Olgahospital – Kinderklinik Stuttgart, Stuttgart, Deutschland

    T. Hospach

  8. St.-Josef-Stift Sendenhorst, Sendenhorst, Deutschland

    A. Illhardt

  9. Kinderkrankenhaus der Stadt Köln, Köln, Deutschland

    K. Mönkemöller

  10. Kinderklinik, Universitätsklinik Dresden, Dresden, Deutschland

    M. Richter

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Die englische Volltextversion dieses Beitrags und der Evidenzbericht sind in SpringerLink zugänglich (unter „Supplemental“).

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English version of "Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des sogenannten Fibromyalgiesyndroms bei Kindern und Jugendlichen" (PDF 0,4 MB)

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Evidenzbericht: Forest Plots der standardisierten Mittelwertdifferenzen von experimenteller Gruppe versus Kontrollgruppe bei ausgewählten Zielvariablen am Therapieende und bei Nachuntersuchungen (PDF 0,4 MB)

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Evidence report: Forest Plots of standardised mean differences between experimental groups versus controls on selected outcomes at final treatment and at follow up (PDF 0,4 MB)

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Evidenzbericht: Tabellen - Charakteristiken der Studien, die in qualitative und/oder quantitative Analyse einbezogen wurden (PDF 0,3 MB)

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Evidence report: Tables - Characteristics of studies included into qualitative and/or quantitative analysis (PDF 0,7 MB)

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Zernikow, B., Gerhold, K., Bürk, G. et al. Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des sogenannten Fibromyalgiesyndroms bei Kindern und Jugendlichen. Schmerz 26, 318–330 (2012). https://doi.org/10.1007/s00482-012-1168-y

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