Das Fibromyalgiesyndrom als Schmerzsyndrom in der Rheumatologie

Was ist neu?

Epidemiologie und Pathophysiologie Das Fibromyalgiesyndrom (FMS) ist bei Menschen mit rheumatologischen Erkrankungen deutlich häufiger als in der Allgemeinbevölkerung. Es kann aber auch unabhängig von anderen Erkrankungen auftreten. Es handelt sich um eine multifaktorielle Erkrankung: Physische und psychosoziale Faktoren wirken bei der Genese zusammen. Pathophysiologisch relevant scheint insbesondere eine gestörte Schmerzverarbeitung zu sein. Ob eine Small-Fiber-Neuropathie (SFN) ursächlich ist, muss weiter untersucht werden. Aktuell gibt es erstmals experimentelle Hinweise darauf, dass es sich beim FMS um eine transferierbare (Autoimmun-)Erkrankung handeln könnte.

Symptome und Diagnostik Es handelt sich beim FMS um eine klinische Diagnose: Neben generalisierten Schmerzen bestehen häufig Schlafstörungen und eine Erschöpfungsneigung – auch eine Assoziation mit einer depressiven Erkrankung kann bestehen. Bei der Diagnose und der Beurteilung des Schweregrads helfen der Widespread-Pain-Index (WPI) und der Symptome-Severity-Score (SSS).

Therapie Neben der Aufklärung über die Gutartigkeit der Erkrankung stehen nicht-medikamentöse Verfahren wie Bewegung, physikalische Therapie und kognitive Verhaltenstherapie im Vordergrund. Bei schwer zu behandelnden Verläufen kann eine multimodale Therapie indiziert sein. Analgetika, insbesondere Opioide, sollen allenfalls nachrangig und kurzfristig zum Einsatz kommen. Der Opioidantagonist Naltrexon ist ein vielversprechender Kandidat zur medikamentösen Therapie. Möglicherweise kann auch die TENS-Nutzung hilfreich sein. Im Hinblick auf den therapeutischen Einsatz von Cannabinoiden gibt es positive Beobachtungsstudien, es fehlt aber weiterhin an Evidenz aus kontrollierten Studien.

Abstract

Epidemiology and pathophysiology: Fibromyalgia is significantly more common in people with rheumatic diseases than in the general population. Nevertheless, it can occur independent of other diseases. Physical and psychosocial factors are responsible for the genesis for fibromyalgia making it a multifactorial disease. Most importantly, central pain processing seems to be abnormal. The relevance of a small fibre neuropathy is yet to be determined. For the very first time, a study was able to demonstrate that fibromyalgia might be passively transferred from one organism to another in an experimental setting.

Diagnosis: Fibromyalgia is a clinical diagnose. Besides generalized pain, sleep disturbances and fatigue are common features. Furthermore, there can be an association with depressive disorders. Determining the Widespread Pain Index (WPI) and the Symptom Severity Score (SSS) can help in diagnosing Fibromyalgia and to determine severity of the disease.

Therapy: Cornerstones of the treatment are patient education, physical exercise, physical therapy, and cognitive behavioural therapy. In therapy-resistant cases, a multimodal approach might be considered. Analgesic drugs, particularly opioids, should basically be avoided or only be used for a short period of time. Naltrexone, an opioid antagonist, is a promising treatment candidate. Another possible approach might be the use of TENS. While there are positive observational studies on the therapeutic use of cannabinoids, evidence from controlled trials is still missing.

Schlüsselwörter

Chronischer Schmerz - Fibromyalgiesyndrom - Pathophysiologie - aktuelle Empfehlungen - Therapieansätze - NSAR - Opioide

Keywords

chronic pain - fibromyalgia - pathophysiology - current recommendations - therapeutic approaches - NSAIDs - opioids

Publication History

Article published online:
02 November 2023

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