[What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association]. / Was sind die Kernsymptome des Fibromyalgiesyndroms? Umfrageergebnisse der Deutschen Fibromyalgievereinigung.

INTRODUCTION: A new definition of fibromyalgia syndrome (FMS) based on symptoms and without tender points is discussed from a rheumatological viewpoint. METHODS: The German Fibromyalgia Association (DFV) developed a questionnaire on potential symptoms in FM based on a list of symptoms established by members of the DFV. The questionnaire was sent to all 3,996 members of the DFV. RESULTS: Of the 753 questionnaires 699 were returned (95% women, most frequent age between 50-60 years) and evaluated. The rank order of the most frequent symptoms (>or=97% of the respondents) was muscle pain with varying locations, low back pain, fatigue, morning stiffness, non-restorative sleep, concentration problems, lack of energy, low productivity and forgetfulness. CONCLUSION: The key symptoms of FM are chronic widespread pain, non-restorative sleep and subjective disabilities. The frequency of general and extra-musculoskeletal symptoms underlines that FMS is more than just a "pain disorder".

[Physiotherapy, exercise and strength training and physical therapies in the treatment of fibromyalgia syndrome]. / Physiotherapie, medizinische Trainingstherapie und physikalische Therapie beim Fibromyalgiesyndrom.

BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Aerobic exercise training is strongly recommended (grade A) and the temporary use of whole body hyperthermia, balneotherapy and spa therapy is recommended (grade B). CONCLUSION: The significance which can be assigned to most of the studies on the various procedures for therapy is restricted due to short study duration (mean 6-12 weeks) and small sample sizes.

[Alternative and complementary therapies in fibromyalgia syndrome]. / Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom.

INTRODUCTION: Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process. METHODS: On the bases of the "Cochrane Library" (1993-2006), "Medline" (1980-2006), "PsychInfo" (2006) and "Scopus" (2006) controlled studies and meta-analyses of controlled studies were analyzed. RESULTS: Only few controlled studies were found supporting in part the effectiveness of CAM therapies in the treatment of fibromyalgia syndrome. Due to the lack of information on long term efficacy and cost-effectiveness, only limited recommendations for CAM therapies can be given. CONCLUSION: Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.

[Steps towards a symptom-based diagnosis of fibromyalgia syndrome. Symptom profiles of patients from different clinical settings]. / Schritte zu einer symptombasierten Diagnose des Fibromyalgiesyndroms. Beschwerdeprofile von Patienten unterschiedlicher klinischer Kontexte.

BACKGROUND: A symptom-based diagnosis of fibromyalgia syndrome (FMS) without tender point examination is helpful for primary medical care. We tested whether a symptom-based diagnosis of FMS can be based on the symptoms of musculoskeletal pain and fatigue. METHODS: The most frequent and severe symptoms in FMS patients from four different settings (n= 464 from a self-help organization, n=162 from medical expertise, n= 33 from a private rheumatology practice, n=36 from a tertiary-care pain department) were assessed using the Giessen Subjective Complaints List GBB 24. The most frequent and severe symptoms were assessed and compared to those of a representative German population sample. A k-means cluster analysis was performed to identify sub-groups with and without additional vegetative symptoms within the total sample of FMS patients. RESULTS: The most frequent and severe symptoms in all four sub-samples were low back pain, limb pain and fatigue. The greatest mean differences between FMS patients and the general population were found in the subscales "limb pain" and "fatigue". Cluster analysis identified three sub-groups of patients which were all characterized by severe limb pain and fatigue, as well as varying degrees of vegetative symptoms. SUMMARY: Following the exclusion of inflammatory rheumatoid, endocrinological and neurological diseases, a symptom-based clinical diagnosis of FMS can be based on of the key symptoms of chronic widespread musculoskeletal pain, as well as chronic fatigue.

[Psychotherapy in patients with fibromyalgia syndrome]. / Psychotherapie bei Patienten mit Fibromyalgiesyndrom.

BACKGROUND: A guideline for the treatment and diagnostic procedures in fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies of evaluated multicomponent therapy was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Cognitive and operant behavioral therapy is strongly recommended (grade A). Guided imagery/hypnotherapy and written emotional disclosure are recommended (grade B). CONCLUSIONS: Psychotherapeutic programs tailored to FMS subgroups should be developed and tested.

[Principles of treatment, coordination of medical care and patient education in fibromyalgia syndrome and chronic widespread pain]. / Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom und chronischen Schmerzen in mehreren Körperregionen.

BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Patient's information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). CONCLUSIONS: The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.