Fibromyalgie als Störung der zentralen Schmerz- und Stressverarbeitung

Zusammenfassung

Unter Fibromyalgie versteht man heute üblicherweise ein multilokuläres chronisches Schmerzsyndrom unklarer Ätiopathogenese. In den letzten Jahren weisen immer mehr wissenschaftliche Studienergebnisse darauf hin, dass psychosozialen Stressoren eine zentrale pathogenetische Bedeutung zukommt. Ausgehend von der Funktion und der Entwicklung des Stressverarbeitungssystems wird der gegenwärtige Wissenstand seiner Wechselwirkung mit dem zentralen Schmerzverarbeitungssystem zusammengefasst. Frühe Stresserfahrungen können Ausreifung und spätere Funktion des Stresssystems lebenslang erheblich beeinträchtigen. Auf diesem Hintergrund wird dann der gegenwärtige Forschungsstand zur Bedeutung von Stress für die Ätiopathogenese der Fibromyalgie zusammengefasst. Sowohl psychologische als auch psychobiologische Konsequenzen werden dargestellt. Schließlich wird ein integratives biopsychosoziales Pathogenesemodell entwickelt, das eine Reihe von Mosaiksteinen zusammenzufügen sucht. Dieses bietet die Möglichkeit zur Differenzierung pathogenetischer Subgruppen sowie eine klinische Orientierungshilfe, um für den einzelnen Patienten eine gezieltere Therapieplanung vorzunehmen.

Abstract

Fibromyalgia is often understood as a syndrome mainly characterised by widespread pain and tenderness and „unexplained” etiology and pathogenesis. In the last years evidence is growing that biological as well as psychosocial stress play a pathogenetic key-role. Beginning with the general function and development of the stress response system the actual knowledge of its relationship with central pain-processing mechanisms is reviewed. Early adverse childhood experiences can impair the function of the stress system all over the lifespan. Subsequently, research evidence for the role of stress in the etiopathogenesis of fibromyalgia is summarised. Psychological as well as psychobiological consequences are outlined. Finally, an integrative model of fibromyalgia is proposed, which may put several pieces of a biopsychosocial puzzle together. This model offers an approach for the differentiation of subgroups and a clinical orientation for developing an adequate therapy for the individual patient.

Key words

Fibromyalgia - stress - pathogenesis - childhood adversities - abuse

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