Fibromyalgie: Eine körperliche Krankheit oder unspezifische psychische Störung?
Abstract
Zusammenfassung. Die Fibromyalgie (FM) ist eine multilokale, nichtentzündliche Schmerzstörung an bestimmten druckschmerzhaften Punkten des Bewegungsapparates. Hinzu treten multiple funktionelle Symptome wie Schlafstörungen, Magen- und Darmbeschwerden, Konzentrationsstörungen und nicht zuletzt psychische Beeinträchtigungen und Störungen (Depression, Angst, eingeschränkte Lebensqualität). Bei Kindern und Jugendlichen stellt die FM eine eher seltene Extremform weitverbreiteter funktioneller Schmerzstörungen des Bewegungsapparates dar. Die medizinische Diagnostik ergibt keinen pathologischen Befund. Entsprechend kontrovers wird die Ätiopathogenese diskutiert. Drei Störungsmodelle werden vorgestellt: (1) FM als organische Erkrankung auf der Basis einer genetischen Prädisposition, mit Regulationsstörungen der Hormonachse, des Vegetativums und der Neurotransmittersysteme, (2) FM als chronisch-funktionelle Schmerzstörung infolge einer Schmerzsensitivierung und -verstärkung (Wind-up-Phänomen), (3) FM als psychische Störung mit hoher Komorbidität im Bereich der Depression und Angststörungen im Sinne einer somatoformen Schmerzstörung mit katastrophisierender Symptomverarbeitung und exzessiv gesteigertem Krankheits- und Inanspruchnahmeverhalten. Zur Integration dieser Störungsmodelle stellt der Beitrag ein entwicklungspsychopathologisches Modell vor. Es unterscheidet vier Störungsetappen, denen jeweils spezifische medizinische wie psychologische Interventionsmethoden zugeordnet werden können; ausführlich werden verhaltensmedizinische Strategien vorgestellt.
Abstract. Fibromyalgia (FM) is a multilocal, noninflammatory pain disorder manifesting as specific tender points of the musculoskeletal system. It includes multiple functional symptoms like sleep disorders, gastrointestinal dysfunction, attention deficit, and unspecific psychological disturbances (depression, anxiety, functional disability, impaired quality of life). In children and adolescents, FM represents the extreme form of frequent musculoskeletal pain syndromes. Medical assessment does not reveal any specific pathological findings. As a result, concepts on aetiology are controversial. Three concepts are outlined: (1) FM as a somatic disorder based on a genetic predisposition affecting the regulation of the hormone axis, the autonomic nervous system, and neurotransmitter systems, (2) FM as a chronic functional pain disorder based on a pain sensitization and amplification process on spinal and central level (wind-up-phenomenon), (3) FM as a psychopathological disorder characterized by a high comorbidity with depression and anxiety disorders, manifesting as a somatoform pain disorder associated with a catastrophizing symptom perception and excessive pain behavior. The paper introduces an integrative concept from the perspective of developmental psychopathology delineating four stages of disorder development with corresponding medical and psychological treatment options; behavioral medicine strategies are outlined in detail.
Literatur
(1998). Sexual and physical abuse in women with fibromyalgia: Association with outpatient health care utilization and pain mediation usage. Arthritis Care and Research , 11 , 102– 115 .
(2001). Juvenile primary fibromyalgia syndrome. Current Rheumatology Research , 3 , 165– 171 .
(2004). Family study of fibromyalgia. Arthritis and Rheumatism , 50 , 944– 952 .
(2002). The Arthritis Foundation's guide to good living with fibromyalgia. Atlanta, GA: Arthritis Foundation .
(2006). Cognitive behavioral therapy for fibromyalgia. Nature Clinical Practice Rheumatology , 2 , 416– 424 .
(2007). Genetics of chronic pain states. Best Practice and Research Clinical Rheumatology , 21 , 35– 47 .
in press EULAR evidence based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases .
(2003). Temperament and stress response in children with juvenile primary fibromyalgia syndrome. Arthritis and Rheumatism , 48 , 2923– 2930 .
(1994). Population study of tender point counts and pain as evidence of fibromyalgia. British Medical Journal , 309 , 696– 699 .
(2006). Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia. Journal of Pediatric Psychology , 31 , 714– 723 .
(2006). Catechol-O-methyltransferase gene polymorphisms are associated with multiple pain-evoking stimuli. Pain , 125 , 216– 224 .
(2006). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis and Rheumatism , 55 , 325– 332 .
(2004). Fibromyalgie als Störung der zentralen Schmerz- und Stressverarbeitung. Ein neues biopsychosoziales Krankheitsmodell. Psychotherapie, Psychiatrie, Medizinische Psychologie , 54 , 137– 147 .
(2003). Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behaviour Research and Therapy , 41 , 1295– 1310 .
(2000). Fibromyalgia syndrome: experience in a pediatric rheumatology clinic. Clinical and Experimental Rheumatology , 18 , 415– 419 .
(2005). The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis and Rheumatism , 52 , 1577– 1584 .
(2003). Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis and Rheumatism , 48 , 2916– 2922 .
(2007). Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain. Best Practice and Research Clinical Rheumatology , 21 , 499– 511 .
(2004). Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain , 127 , 835– 843 .
(2002). Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis and Rheumatism , 46 , 1333– 1343 .
(2004). Ist die Fibromyalgie eine Krankheit? - Contra. Deutsche Medizinische Wochenschrift , 129 , 1337– 1337 .
(1996). If you have to prove you are ill, you can't get well. The object lesson of fibromyalgia. Spine , 21 , 2397– 2400 .
(2006). Das Fibromyalgiesyndrom - eine somatoforme (Schmerz)störung?. Schmerz , 20 , 128– 139 .
(2003). Childhood adversities in patients with fibromyalgia and somatoform pain disorder. European Journal of Pain , 7 , 113– 119 .
(2005). Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain , 114 , 295– 302 .
(2000). A review of biobehavioral research in juvenile primary fibromyalgia syndrome. Arthritis Care and Research , 13 , 388– 397 .
(2000). Fibromyalgia syndrome in children and adolescents. Journal of Musculoskeletal Medicine , 17 , 142– 158 .
(2007). Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients. Annals of Behavioral Medicine , 33 , 291– 301 .
(2002). Memory for pain: The relationship of pain catastrophizing to the recall of daily rheumatoid arthritis pain. Clinical Journal of Pain , 18 , 56– 63 .
(2007). Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Practice and Research Clinical Rheumatology , 21 , 513– 534 .
(2005). Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents. Arthritis Research and Therapy , 7 , 992– 1000 .
(2007). Epidemiology of chronic musculoskeletal pain. Best Practice and Research Clinical Rheumatology , 21 , 403– 425 .
(2007). Stress-related musculoskeletal pain. Best Practice and Research Clinical Rheumatology , 21 , 549– 565 .
(1999). One year outcome of preadolescents with fibromyalgia. Journal of Rheumatology , 26 , 674– 682 .
(2004). Das Konzept der Selbstwirksamkeit als bedeutsamer Prädiktor anhaltenden Behandlungserfolgs von Fibromyalgie-Patienten. Aktuelle Rheumatologie , 29 , 101– 108 .
(2006). Human catechol-O-methyltransferase haplotypes modulate protein expression by altering mRNA secondary structure. Science , 314 , 1930– 1933 .
(2007). Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): The role of central and peripheral sensitization and pain disinhibition. Best Practice and Research Clinical Rheumatology , 21 , 465– 480 .
(2004). Relationship between changes in coping and treatment outcome in patients with Fibromyalgia Syndrome. Pain , 109 , 233– 241 .
(2008). Funktionelle und somatoforme Störungen im Kindes- und Jugendalter. Göttingen: Hogrefe .
(1998). Children's and adolescents' perception of their asthma bronchiale. Child: Care, Health and Development , 24 , 21– 30 .
(2003). Entwicklungsorientierte Betrachtung chronischer Krankheiten im Kindes- und Jugendalter. Zeitschrift für Klinische Psychologie, Psychopathologie und Psychotherapie , 51 , 191– 229 .
(2008). Chronische Erkrankungen im Jugendalter. In F. Petermann & W. Schneider (Hrsg.), Angewandte Entwicklungspsychologie (S. 635-676). Göttingen: Hogrefe .
(2004). Compliance in der Behandlung Rheumakranker: Ein Marathonlauf. Aktuelle Rheumatologie , 29 , 67– 74 .
(2007). Verhaltensmedizinische Behandlungsstrategie der Fibromyalgie. Schmerz , 21 , 469– 478 .
(2000). Do fibromyalgia patients display hypervigilance for innocuous somatosensory stimuli? Application of a body scanning reaction time paradigm. Pain , 86 , 283– 292 .
(1998). Social context of pain in children with juvenile primary fibromyalgia syndrome: Parental pain history and family environment. Clinical Journal of Pain , 14 , 107– 115 .
(1996). Pain coping strategies in children with juvenile primary fibromyalgia syndrome: Correlations with pain, physical function, and psychological distress. Arthritis Care and Research , 9 , 89– 96 .
(2003). Elements of fibromyalgia in an open population. Rheumatology , 42 , 829– 835 .
(2004). Pain catastrophizing is associated with health indices in musculoskeletal pain: A cross-sectional study in the Dutch community. Health Psychology , 23 , 49– 57 .
(1991). Psychosomatic musculoskeletal pain in childhood: Clinical and psychological analyses of 100 children. Pediatrics , 88 , 1093– 1099 .
(1998). Fibromyalgia syndrome in children and adolescents: Clinical features at presentation and status at follow-up. Pediatrics , 101 , 377– 382 .
(2006). Biology and therapy of fibromyalgia: Pain in fibromyalgia syndrome. Arthritis Research and Therapy , 8 , 208– 208 .
(2007). Future perspectives: Pathogenesis of chronic muscle pain. Best Practice and Research Clinical Rheumatology , 21 , 581– 596 .
(2001). Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain , 91 , 165– 175 .
(2006). Overall fibromyalgia pain is predicted by ratings of local pain and pain-related negative affect - possible role of peripheral tissues. Rheumatology , 45 , 1409– 1415 .
(2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain , 17 , 52– 64 .
(2005). Relationship of pain-coping strategies and pain-specific beliefs to pain experience in children with juvenile idiopathic arthritis. Arthritis and Rheumatism , 53 , 178– 184 .
(2007). Quality of life in chronic musculoskeletal pain. Best Practice and Research Clinical Rheumatology , 21 , 567– 579 .
(2007). Resting muscle pain as the first clinial symptom in children carrying the MTTK A8344 G mutation. European Journal of Paediatric Neurology , 11 , 243– 246 .
(2004). Fibromyalgia: A stress disorder? Piecing the biopsychological puzzle together. Psychotherapy and Psychosomatics , 73 , 267– 275 .
(2005). The role of life stress in fibromyalgia. Current Rheumatology Reports , 7 , 365– 370 .
(1994). A bio-psychological evaluation of ten adolescents with fibromyalgia. Acta Paediatrica , 83 , 766– 771 .
(1996). The fibromyalgia syndrome: A consensus report on fibromyalgia and disability. Journal of Rheumatology , 23 , 534– 539 .
(1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the Multicenter Criteria Committee. Arthritis and Rheumatism , 33 , 160– 172 .
(1985). Juvenile primary fibromyalgia syndrome. A clinical study of thirty patients and matched normal controls. Arthritis and Rheumatism , 28 , 138– 145 .
