RESUMO
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized, controlled trials on patient education and shared decision-making from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences, clinical and practical applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: The diagnosis of fibromyalgia syndrome should be explicitly communicated to the affected individual. Shared decision-making with the patient on the therapeutic options based on individual preferences of the patient, comorbidities and the success of previous treatment is recommended. A step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.
Assuntos
Fibromialgia/diagnóstico , Fibromialgia/terapia , Comunicação Interdisciplinar , Colaboração Intersetorial , Educação de Pacientes como Assunto/métodos , Guias de Prática Clínica como Assunto , Tomada de Decisões , Fibromialgia/classificação , Alemanha , Humanos , Sociedades MédicasRESUMO
BACKGROUND: Systematic reviews have reported a wide range of prevalence rates for depressive, anxiety and posttraumatic stress disorders (PTSD) in patients with fibromyalgia syndrome (FMS) which have been partially explained by setting differences. No data are currently available on the prevalence of potential mental disorders depending on the medical specialty in Germany. MATERIAL AND METHODS: All consecutive FMS patients of 8 study centres (3 rheumatology/orthopaedic surgery, 3 psychosomatic/pain medicine, 2 physical/integrative medicine) were assessed from February 1 to July 31, 2012 with standardised questionnaires. Patients with FMS diagnosed by a study physician were included. Non-German speaking and mentally retarded patients were excluded. The German version of the Patient Health Questionnaire 4 was used to screen for potential depressive and anxiety disorders. Severe life events were assessed by the trauma list of the Munich Composite International Diagnostic Interview and symptom criteria of PTSD of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using the Posttraumatic Diagnostic Scale. RESULTS: Of 538 patients, 396 patients (93.9 % women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years, mean duration since FMS diagnosis 4.5 years) were analysed. In all, 65.7 % of patients met the criteria of a potential depressive disorder, 67.9 % of a potential anxiety disorder and 45.5 % of a potential PTSD. Potential depressive disorders were more frequent in the psychosomatic/pain medicine setting than in the rheumatology setting. CONCLUSION: Potential mental disorders were frequent in FMS patients regardless of the medical specialty. All FMS patients of all types of clinical settings should be screened for mental disorders.
Assuntos
Fibromialgia/epidemiologia , Fibromialgia/psicologia , Programas de Rastreamento , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Comorbidade , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Fibromialgia/diagnóstico , Alemanha , Humanos , Entrevista Psicológica , Acontecimentos que Mudam a Vida , Masculino , Medicina , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/epidemiologia , Transtornos Psicofisiológicos/psicologia , Papel do Doente , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: No data were available on demographic and clinical characteristics of members of fibromyalgia syndrome (FMS) self-help groups in Germany. MATERIAL AND METHODS: The study was carried out from November 2010 to April 2011. A set of questionnaires was distributed by the German League Against Rheumatism and the German Fibromyalgia Association to members and to all consecutive FMS patients at nine clinical centres of different levels of care. The set included a self-developed questionnaire on demographic and medical data and on previously and currently used therapies, the patient health questionnaire (PHQ 4) and the fibromyalgia survey questionnaire. RESULTS: Members of FMS self-help groups (N = 1,014) were older and reported a longer duration of chronic widespread pain, less anxiety and depression and a more frequent current use of aerobic exercise, relaxation training and complementary alternative medication than participants not affiliated with FMS self-help groups (N = 630). CONCLUSIONS: Membership in FMS self-help groups was associated with less psychological distress and a more frequent use of active self-management strategies.
Assuntos
Dor Crônica/epidemiologia , Dor Crônica/reabilitação , Terapia por Exercício/estatística & dados numéricos , Fibromialgia/epidemiologia , Fibromialgia/reabilitação , Terapia de Relaxamento/estatística & dados numéricos , Grupos de Autoajuda/estatística & dados numéricos , Distribuição por Idade , Comorbidade , Terapias Complementares/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
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 recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. 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: Cognitive behavioral therapy combined with aerobic exercise (multicomponent therapy) is strongly recommended. Relaxation as single therapy should not be applied. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Assuntos
Fibromialgia/psicologia , Fibromialgia/reabilitação , Psicoterapia , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/reabilitação , Biorretroalimentação Psicológica , Terapia Cognitivo-Comportamental , Terapia Combinada , Comportamento Cooperativo , Medicina Baseada em Evidências , Exercício Físico , Humanos , Hipnose , Imagens, Psicoterapia , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Terapia de Relaxamento , RedaçãoRESUMO
BACKGROUND: Consumer reports provide information on benefits and harms in routine clinical care. We report the first fibromyalgia syndrome (FMS) consumer reports in Europe. MATERIAL AND METHODS: The study was carried out from November 2010 to April 2011. The benefits and harms of pharmacological and non-pharmacological therapies experienced by the patient were assessed in an 11-point Likert scale (0=no, 10=very high benefit or harm) by a questionnaire. The questionnaire was distributed by the German League against Rheumatism and the German Fibromyalgia Association to their members and to all consecutive FMS patients of nine clinical centers of different levels of care. RESULTS: A total of 1,661 questionnaires (95% women, mean age 54 years) were analyzed. Self-management strategies (distraction, resting, aerobic exercise), physical therapies (warm and pool therapies), psychological therapies (education, psychotherapy), and inpatient multicomponent therapies were judged to be more efficacious and less harmful than all types of pharmacological therapies. CONCLUSION: The German fibromyalgia consumer reports highlight the importance of non-pharmcological therapies in the long-term management of FMS.
Assuntos
Fibromialgia/reabilitação , Satisfação do Paciente , Adulto , Idoso , Analgésicos/uso terapêutico , Terapia Combinada , Comportamento Cooperativo , Medicina Baseada em Evidências , Feminino , Humanos , Comunicação Interdisciplinar , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Centros de Reabilitação , Medição de Risco , Inquéritos e QuestionáriosRESUMO
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: A diagnosis of FMS should be explicitly communicated with the afflicted individual. A step-wise treatment, depending on the severity of FMS and the responses to therapeutic measures, is recommended. Therapy should only be continued if the positive effects outweigh the side effects. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Assuntos
Comportamento Cooperativo , Fibromialgia/reabilitação , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Adulto , Terapia Combinada , Comunicação , Medicina Baseada em Evidências , Fibromialgia/diagnóstico , Fibromialgia/psicologia , Humanos , Dor Intratável/diagnóstico , Dor Intratável/psicologia , Dor Intratável/reabilitação , Admissão do Paciente , Assistência Centrada no Paciente , Centros de Reabilitação , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/reabilitaçãoRESUMO
BACKGROUND: A guideline for the treatment of 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 multicomponent therapy (MT) was performed in the Cochrane Library (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: MT is superior to control groups or routine treatment (evidence level 1A) and should be offered to FMS patients (recommendation strength A). CONCLUSIONS: Future studies should consider medication, other co-therapies and comorbidities. MT programs tailored to FMS subgroups should be tested.
Assuntos
Fibromialgia/reabilitação , Equipe de Assistência ao Paciente , Terapia Combinada , Medicina Baseada em Evidências , Fibromialgia/diagnóstico , Alemanha , Humanos , Grupos de Autoajuda , Sociedades MédicasRESUMO
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.