ABSTRACT
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 literature search for systematic reviews of randomized, controlled trials on physiotherapy, occupational therapy and physical therapy 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: Low to moderate intensity endurance and strength training are strongly recommended. Chiropractic, laser therapy, magnetic field therapy, massage and transcranial magnetic stimulation are not recommended.
Subject(s)
Fibromyalgia/therapy , Occupational Therapy , Physical Therapy Modalities , Practice Guidelines as Topic , Combined Modality Therapy , Exercise , Fibromyalgia/diagnosis , Humans , Patient Care Team , Societies, MedicalABSTRACT
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 literature search for systematic reviews of randomized controlled drug trials 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: Amitriptyline and duloxetine are recommended in the case of comorbid depressive disorders or generalized anxiety disorder and pregabalin in the case of generalized anxiety disorder. Off-label use of duloxetine and pregabalin can be considered if there are no comorbid mental disorders or no generalized anxiety disorder. Strong opioids are not recommended.
Subject(s)
Fibromyalgia/drug therapy , Practice Guidelines as Topic , Amitriptyline/therapeutic use , Anxiety Disorders/drug therapy , Anxiety Disorders/psychology , Comorbidity , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Duloxetine Hydrochloride/therapeutic use , Evidence-Based Medicine , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Germany , Humans , Pregabalin/therapeutic use , Randomized Controlled Trials as Topic , Societies, MedicalABSTRACT
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.
Subject(s)
Fibromyalgia/diagnosis , Fibromyalgia/therapy , Interdisciplinary Communication , Intersectoral Collaboration , Patient Education as Topic/methods , Practice Guidelines as Topic , Decision Making , Fibromyalgia/classification , Germany , Humans , Societies, MedicalABSTRACT
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").
Subject(s)
Cooperative Behavior , Fibromyalgia/rehabilitation , Interdisciplinary Communication , Patient Care Team , Patient Education as Topic , Adult , Combined Modality Therapy , Communication , Evidence-Based Medicine , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Humans , Pain, Intractable/diagnosis , Pain, Intractable/psychology , Pain, Intractable/rehabilitation , Patient Admission , Patient-Centered Care , Rehabilitation Centers , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
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: The use of a multicomponent therapy (the combination of aerobic exercise with at least one psychological therapy) for a minimum of 24 h is strongly recommended for patients with severe FMS. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Subject(s)
Cooperative Behavior , Fibromyalgia/rehabilitation , Interdisciplinary Communication , Patient Care Team , Adult , Combined Modality Therapy/methods , Evidence-Based Medicine , Exercise , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Follow-Up Studies , Humans , Patient Admission , Psychotherapy , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
To date, the long-term course of fibromyalgia (FM) generally shows little improvement and many patients have problems managing their private, social and professional lives, if at all. Health workers in various specialties, and even in the same specialty, have differing concepts on etiology, diagnosis and treatment of FM. In its work spanning 2 years, an interdisciplinary working group made up from 10 scientific associations reviewed the literature and developed an S3-level consensus guideline. Various etiopathogenetic concepts converge from the perspective of a biopsychosocial model. A stepwise treatment approach with patient education, endurance training, multi-modal therapy and promotion of significant resources is recommended. Of the psychotherapeutic methods, cognitive behavioural training has proved the most relevant. Only a handful of drug therapies have undergone controlled trials, most however only over a period of a few weeks.
Subject(s)
Fibromyalgia/diagnosis , Fibromyalgia/therapy , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Rheumatology/standards , GermanyABSTRACT
Pain was assessed in 47 patients with fibromyalgia in the University Rheumatology Clinic in Basle with the aid of three different techniques. First, a simple visual analog scale was used, later a body diagram on which patients could indicate pain separately in different regions of the body (pain score) and, finally, dolorimetric measurements at 56 typical PFS tender points. After four weeks of therapy, pain was again scored by patients using these techniques. The changes in assessment were compared with the aid of Spearman correlation. Data recorded with the aid of the body diagram correlated better with dolorimetric findings than did the results obtained from a simple visual analog scale. The severity of the disease can be more objectively assessed using these three techniques than it can using only the visual analog scale. In particular, the pain score and dolorimetry make possible a clear assessment of the value of therapeutic regimens.
Subject(s)
Fibromyalgia/pathology , Pain Measurement , Female , Humans , Male , Middle Aged , Pain/pathology , Pain Measurement/instrumentationABSTRACT
Forty-two patients with psoriatic arthritis were included in a multicenter, double-blind trial comparing auranofin and gold sodium thiomalate (GST) for 6 months, followed by a 6-month open treatment. Fifty-two percent of the patients on auranofin and 33% on GST were able to complete the 1-year course of therapy. As a result of the study we conclude that both gold compounds are effective agents in the treatment of psoriatic arthritis. Degree of improvement of arthritis was better in the GST group, but the number of improved patients was greater in the auranofin group. Two patients on auranofin were withdrawn for side effects (one diarrhoea, one worsening of psoriasis) and 5 on GST (rash 2, total loss of appetite 1, exacerbation of psoriasis 2). Comparing the side effects of both compounds, auranofin is less likely to aggravate the psoriatic condition or result in withdrawal of patients for adverse reactions.
Subject(s)
Arthritis, Psoriatic/drug therapy , Auranofin/therapeutic use , Gold Sodium Thiomalate/therapeutic use , Adult , Aged , Arthritis, Psoriatic/physiopathology , Auranofin/adverse effects , Double-Blind Method , Female , Gold Sodium Thiomalate/adverse effects , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Still's disease was diagnosed in a 40-year-old patient as a cause of psycho-organic syndrome with complete disorientation and stupor, sensory and motor aphasia. There were no signs of a tumour, cerebrovascular accident, bacterial or viral infection. The patient recovered quickly from the cerebral disturbances under treatment with corticosteroids. Similar symptoms in adult patients with Still's disease are seldom found in the literature.
Subject(s)
Meningoencephalitis/etiology , Still's Disease, Adult-Onset/complications , Adrenal Cortex Hormones/therapeutic use , Adult , Female , Humans , Meningoencephalitis/drug therapyABSTRACT
A 32-year-old patient is described presenting with ulcerative colitis and oligoarthritis who later developed benign hypergammaglobulinemic purpura. This diagnosis was confirmed by clinical investigation, immunological findings as well as by histological and immunofluorescent examination. He was successfully treated with steroids and azathioprin. The relevant literature is reviewed.
Subject(s)
Arthritis/complications , Colitis, Ulcerative/complications , Purpura, Hyperglobulinemic/complications , Adult , Arthritis/drug therapy , Azathioprine/therapeutic use , Colitis, Ulcerative/drug therapy , Humans , Male , Prednisone/therapeutic use , Purpura, Hyperglobulinemic/drug therapyABSTRACT
We investigated the efficacy and tolerability of short-term treatment with tropisetron, a selective, competitive 5-HT3-receptor antagonist in fibromyalgia. The trial was designed as a prospective, multicenter, double-blind, parallel-group, dose-finding study. We randomly assigned 418 patients suffering from primary fibromyalgia to receive either placebo, 5 mg, 10 mg or 15 mg tropisetron once daily for 10 days. Clinical response was measured by changes in pain score, visual analog scale, tender point count and ancillary symptoms. Responders were prospectively defined as patients showing a 35% or higher reduction in pain score. Treatment with 5 mg tropisetron resulted in a significantly higher response rate (39.2%) than placebo (26.2%) (p < 0.05). In the visual analog scale, the group administered 5 mg tropisetron showed a significant improvement (p < 0.05) and the group administered 10 mg tropisetron showed a nonsignificant clinical benefit. The number of painful tender points was significantly reduced (p = 0.002) in the 5 mg tropisetron group. Regarding ancillary symptoms, the 5 mg tropisetron group showed a significant improvement (p < 0.05) in sleep and dizziness. The patients' overall assessment of efficacy was significantly higher for 5 mg (p = 0.016) and 10 mg (p = 0.002) tropisetron than for placebo. The safety and tolerability of tropisetron was good; gastrointestinal tract symptoms were the most frequently reported adverse events. Short-term treatment of fibromyalgia patients with 5 mg tropisetron for 10 days proved to be efficacious and well tolerated. In this study a bell-shaped dose-response curve was seen.
Subject(s)
Fibromyalgia/therapy , Indoles/therapeutic use , Receptors, Serotonin/drug effects , Serotonin Antagonists/therapeutic use , Adolescent , Adult , Aged , Double-Blind Method , Female , Fibromyalgia/blood , Half-Life , Humans , Indoles/adverse effects , Male , Middle Aged , Pain Measurement , Prospective Studies , Receptors, Serotonin, 5-HT3 , Serotonin Antagonists/adverse effects , TropisetronSubject(s)
Diagnostic Imaging , Discitis/diagnosis , Staphylococcal Infections , Aged , Discitis/etiology , Female , Humans , Lumbar VertebraeSubject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Osteoarthropathy, Secondary Hypertrophic/diagnostic imaging , Carcinoma, Squamous Cell/complications , Female , Hand/diagnostic imaging , Humans , Lung Neoplasms/complications , Middle Aged , Osteoarthropathy, Secondary Hypertrophic/etiology , RadiographyABSTRACT
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.
Subject(s)
Fibromyalgia/rehabilitation , Patient Care Team , Combined Modality Therapy , Evidence-Based Medicine , Fibromyalgia/diagnosis , Germany , Humans , Self-Help Groups , Societies, MedicalABSTRACT
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.