[EMDR as a psychotherapeutic approach in the treatment of chronic pain : Is Eye Movement Desensitization and Reprocessing an effective therapy for patients with chronic pain who do not suffer from posttraumatic stress disorder?] / EMDR als psychotherapeutischer Ansatz in der Schmerztherapie : Ist "eye movement desensitization and reprocessing" eine wirksame Therapie bei Patienten mit chronischen Schmerzen ohne posttraumatische Belastungsstörung?

The efficacy of Eye Movement Desensitization and Reprocessing (EMDR) has been demonstrated for posttraumatic stress disorder. Despite promising research, it is still not clear if EMDR is a similarly effective treatment for chronic pain. Controlled trials are lacking and whether specific mechanisms underlie the effects remains unknown. The treatment of chronic pain aims at a reduction of subjective pain sensations. To achieve this goal without the usage of pain medications, i. e. through psychotherapy, is desirable for many reasons (e. g. reduction of treatment costs and side effects). Whether or not EMDR is an effective intervention for all chronic pain patients (or just a specific subgroup) constitutes an important question for psychological pain research.

[Psychotherapy and psychological procedures for fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. / Psychotherapie und psychologische Verfahren beim Fibromyalgiesyndrom : Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten.

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 systematic search of the literature for systematic reviews of randomized, controlled studies on psychological and psychotherapeutic procedures 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 and 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: Cognitive behavioral therapies received a strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.

Efficacy, acceptability and safety of guided imagery/hypnosis in fibromyalgia - A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed at evaluating the efficacy, acceptability and safety of guided imagery/hypnosis (GI/H) in fibromyalgia. Cochrane Library, MEDLINE, PsycINFO and SCOPUS were screened through February 2016. Randomized controlled trials (RCTs) comparing GI/H with controls were analysed. Primary outcomes were ≥50% pain relief, ≥20% improvement of health-related quality of life, psychological distress, disability, acceptability and safety at end of therapy and 3-month follow-up. Effects were summarized by a random effects model using risk differences (RD) or standardized mean differences (SMD) with 95% confidence intervals (CI).Seven RCTs with 387 subjects were included into a comparison of GI/H versus controls. There was a clinically relevant benefit of GI/H compared to controls on ≥50% pain relief [RD 0.18 (95% CI 0.02, 0.35)] and psychological distress [SMD -0.40 (95% CI -0.70, -0.11)] at the end of therapy. Acceptability at the end of treatment for GI/H was not significantly different to the control. Two RCTs with 95 subjects were included in the comparison of hypnosis combined with cognitive behavioural therapy (CBT) versus CBT alone. Combined therapy was superior to CBT alone in reducing psychological distress at the end of therapy [SMD -0.50 (95% CI -0.91, -0.09)]. There were no statistically significant differences between combined therapy and CBT alone in other primary outcomes at the end of treatment and follow-up. No study reported on safety. GI/H hold promise in a multicomponent management of fibromyalgia. SIGNIFICANCE: We provide a systematic review with meta-analysis on guided imagery and hypnosis for fibromyalgia. Current analyses endorse the efficacy and tolerability of guided imagery/hypnosis and of the combination of hypnosis with cognitive-behavioural therapy in reducing key symptoms of fibromyalgia.

Changes in root morphology and dry matter production in Pfaffia glomerata (Spreng. ) Pedersen accessions in response to excessive zinc / Alterações na morfologia radicular e produção de matéria seca em acessos de Pfaffia glomerata (Spreng. ) Pedersen em resposta ao excesso de zinco

ABSTRACT Zinc (Zn) participates of numerous metabolic processes in plants. However, it can become toxic to plants in excessive concentrations in the soil. Pfaffia glomerata is a Brazilian medicinal species that has stood out because of its numerous chemical and functional properties, mainly by the triterpene saponins and ecdysteroids accumulated in its roots. This study aimed to evaluate the effects of zinc excess on many root morphological parameters of Pfaffia glomerata. A 4 x 3 factorial design was employed in a completely randomized scheme with 3 replicates. The treatments consisted of four concentrations of Zn (2, 100, 200, and 300 µM) and three accessions of P. glomerata (BRA, GD, and JB) grown in a hydroponic system for 7 and 14 days. Differences in root morphology and dry mass production were observed among the three accessions in response to excessive Zn. Some growth parameters of GD accession increased with the addition of Zn, ranging from 36 to 79 µM. However, the GD and JB accessions presented reduction in dry mass production, root area, length, and volume with increasing Zn levels. The BRA accession, which had the lowest growth among accessions, presented chlorotic leaves. The shoot/root dry mass ratio and root diameter increased linearly for BRA and GD accessions at 7 days. Based on the evaluated parameters, we observed the following order of Zn excess tolerance in P. glomerata accessions: GD> JB> BRA.

RESUMO O zinco (Zn) participa de numerosos processos metabólicos nas plantas. No entanto, em concentrações excessivas no solo pode tornar-se tóxico para os vegetais. Pfaffia glomerata é uma espécie medicinal brasileira que tem se destacado devido as suas inúmeras propriedades químicas e funcionais, devido principalmente às saponinas triterpênicas e ecdisteróides acumuladas em suas raízes. O objetivo do presente trabalho foi avaliar os efeitos do excesso de Zn sobre vários parâmetros morfológicos radiculares de Pfaffia glomerata. O delineamento experimental utilizado foi o inteiramente casualizado com três repetições, dispostos em um arranjo fatorial (4 x 3). Os tratamentos consistiram em quatro níveis de Zn (2, 100, 200 e 300µM) e três acessos (BRA, GD e JB) de P. glomerata cultivados em sistema hidropônico em casa de vegetação por 7 e 14 dias. Diferenças na morfologia radicular e na produção de material seca foram observadas entre os três acessos em resposta ao excesso de Zn. Alguns parâmetros de crescimento do acesso GD aumentaram sob a adição de Zn variando entre 36 e 79 µM. No entanto, os acessos GD e JB apresentaram redução na matéria seca, bem como na área de superfície, comprimento e volume radicular com o aumento dos níveis de Zn. O acesso BRA, que teve o menor crescimento entre os acessos, apresentou folhas cloróticas. A razão entre matéria seca da parte aérea e raízes e o diâmetro radicular aumentou linearmente para os acessos BRA e GD aos 7 dias de cultivo. Baseando-se nos parâmetros avaliados foi observada a seguinte ordem de tolerância ao excesso de Zn: GD> JB> BRA.

[Psychotherapeutic procedures for fibromyalgia syndrome]. / Psychotherapeutische Verfahren beim Fibromyalgiesyndrom.

BACKGROUND: Psychosocial factors play an important role in the predisposition, triggering and course of fibromyalgia syndrome (FMS). Cognitive behavioral therapies are strongly recommended in the current guidelines on the management of FMS in Canada, Germany and Israel. AIMS: Review of techniques, aims and efficacy of psychotherapeutic procedures in FMS. MATERIAL AND METHODS: Narrative review based on a selective search for systematic reviews on the efficacy of psychotherapeutic procedures in FMS. RESULTS: There is robust evidence for the short and long-term efficacy of cognitive behavioral therapies on some key symptoms of FMS, e.g. pain, depression and disability. The quality and quantity of the evidence for the efficacy of other psychotherapeutic procedures (e.g. biofeedback, relaxation therapies, hypnosis/guided imagery and psychodynamic therapy) are insufficient. CONCLUSION: Cognitive behavioral therapies (e.g. acceptance and commitment therapy, cognitive behavioral therapy and operant therapy) should play an important role in a graduated and individually tailored therapy of FMS patients.

[Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. / Psychotherapie von Patienten mit Fibromyalgiesyndrom. Systematische Übersicht, Metaanalyse und Leitlinie.

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").

[Complementary and alternative therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. / Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom. Systematische Übersicht, Metaanalyse und Leitlinie.

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: Meditative movement therapies (qi gong, tai chi, yoga) are strongly recommended. Acupuncture can be considered. Mindfulness-based stress reduction as monotherapy and dance therapy as monotherapy are not recommended. Homeopathy is not recommended. In a minority vote, homeopathy was rated as "can be considered". Nutritional supplements and reiki are not recommended. The English full-text version of this article is available at SpringerLink (under "Supplemental").

[Predictors of successful transfer to everyday live of a relaxation method acquired in psychosomatic rehabilitation]. / Prädiktoren des Alltagstransfers eines stationär erlernten Entspannungstrainings.

AIM OF THE STUDY: The aim of the present study was to identify factors at the beginning and at the end of an inpatient psychosomatic rehabilitation predicting the successful transfer of Progressive Relaxation (PR) according to Jacobson three months after the stay. METHODS: Eighty patients in a psychosomatic rehabilitation centre were studied in the beginning (T1), at discharge (T2) and three months after discharge (T3). Every patient participated in courses on PR. To evaluate the course, parts of the "Diagnostisches und evaluatives Instrumentarium für Entspannungstraining und Entspannungstherapie" were used. Transfer was defined as successful if patients practised PR at least once a week three months after their stay. Potential predictors were: diagnosis, age, symptoms, previous experiences, and motives at T1 and frequency of practising, adequateness of group size and change of symptoms at T2. Stepwise logistic regression analysis was used to identify predictors. RESULTS: Three months after the course 52,5% of the patients were able to transfer PR successfully into their daily lives. 68,8% of cases had been correctly classified by logistic regression through: participation motive "positive thoughts" (T1) and "frequency of practising PR outside the course" (T2). CONSEQUENCES: Intrinsic participation motives and practising independently are significant predictors of long-term transfer of PR. This indicates the necessity of discussing motives at the beginning as well as frequency of practising during the PR course. It would be particularly interesting to know whether specific encouraging of motivation would improve the transfer to everyday life.

[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.

[Predictors of therapeutic success in inpatient psychosomatic rehabilitation of musculo-skeletal diseases]. / Prädiktoren des Behandlungserfolges in der stationären psychosomatischen Rehabilitation muskuloskelettaler Erkrankungen.

The aim of the present study was to identify pre-program factors and treatment-related changes predicting short-term (end of treatment) and long-term (three years after therapy) treatment success in inpatient psychosomatic rehabilitation of musculo-skeletal diseases. Discriminant function analysis of pre-program factors above all revealed a positive influence of a non-existing wish for social compensation, a smaller amount of medical treatment and lower sick leave for short- and long-term therapeutic outcome. Analysis of treatment related changes showed, that an improved mobility, well-being and an ameliovated self-esteem had prognostic value for short-term success. Long-term success was predicted by improved well-being, an improvement of understanding between physician and patient and by decreased depressive symptoms in the course of treatment.