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 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.
Subject(s)
Fibromyalgia/psychology , Fibromyalgia/therapy , Practice Guidelines as Topic , Psychological Techniques , Psychotherapy/methods , Cognitive Behavioral Therapy , Combined Modality Therapy , Germany , Humans , HypnosisABSTRACT
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 of randomized controlled trials of complementary and alternative therapies 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 formed 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: Meditative movement therapies (e.g. qi gong, tai chi and yoga) are strongly recommended. Acupuncture and weight reduction in cases of obesity can be considered.
Subject(s)
Complementary Therapies/methods , Fibromyalgia/therapy , Practice Guidelines as Topic , Consensus Development Conferences as Topic , Evidence-Based Medicine , Fibromyalgia/diagnosis , Germany , Humans , Randomized Controlled Trials as Topic , 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 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").
Subject(s)
Complementary Therapies/methods , Fibromyalgia/rehabilitation , Cooperative Behavior , Evidence-Based Medicine , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Germany , Humans , Interdisciplinary Communication , Pain Measurement , Patient Care Team , Quality of Life/psychology , Randomized Controlled Trials as TopicABSTRACT
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.
Subject(s)
Complementary Therapies , Fibromyalgia/therapy , Evidence-Based Medicine , Germany , Humans , Patient Care Team , Self-Help Groups , Societies, MedicalABSTRACT
Caveolae are small, functionally important membrane invaginations found on the surface of many different cell types. Using electron microscopy, caveolae can be unequivocally identified in cell membranes by virtue of their size and the presence of caveolin/VIP22 proteins in the caveolar coat. In this study we have applied for the first time scanning force microscopy (SFM), to visualize caveolae on the surface of living and fixed cells. By scanning the membranes of Chinese hamster ovary cells (CHO), using the tapping mode of the SFM in fluid, we could visualize small membrane pits on the cell membranes of living and fixed cells. Two populations of pits with mean diameters of around 100 nm and 200 nm were present. In addition, the location of many pits visualized with the SFM was coincident with membrane spots fluorescently labeled with a green fluorescent protein-caveolin-1 fusion protein. Scanning force microscopy on cells treated with methyl-beta-cyclodextrin, an agent that sequesters cholesterol and disrupts caveolae, abolished pits with a measured diameter of 100 nm but left pits of around 200 nm diameter intact. Thus, the smallest membrane pits measured with the SFM in CHO cells were indeed very likely to be identical to caveolae. These experiments show for the first time that SFM can be used to visualize caveolae in intact cells.
Subject(s)
Caveolae/metabolism , Caveolae/ultrastructure , Caveolins/metabolism , Caveolins/ultrastructure , Microscopy, Atomic Force/methods , Microscopy, Fluorescence/methods , Subtraction Technique , Animals , CHO Cells , Caveolin 1 , Cell Membrane/ultrastructure , Cricetinae , Cricetulus , Particle Size , Surface PropertiesABSTRACT
After 3 years of clinical work the first experiences in founding a pain outpatient clinic shall be reported. Meanwhile we treat about 150 patients every 3 months with more than 300 contacts. Patients suffer from headache, back pain, neuropathic,rheumatic and other pain states, but not cancer pain. Therapy lasts for 18 to 24 months. The different procedures presented as follows are performed with regard to lawful structures and orders. Difficulties consist of logistic transfer, financial problems and professional occupations, so that criteria for real interdisciplinarity are not yet fulfilled.
Subject(s)
Ambulatory Care Facilities/organization & administration , Outpatients , Pain Management , Ambulatory Care Facilities/economics , Ambulatory Care Facilities/statistics & numerical data , Germany , Headache/therapy , Humans , Rheumatic Diseases/physiopathologyABSTRACT
Relationships between the structure of transfecting complexes of histone H1 and DNA and their transfection efficiency were studied. Transfection activity proved to be connected to complex aggregates. Low speed centrifugation of the complexes resulted in loss of the transfection activity. The complexes/aggregates were active with high efficiency in a broad range of weight input ratios r(i) (0.1 < r(i) < 30). Using atomic force microscopy (AFM), the complexes were imaged at negative, nearly electroneutral and positive charge conditions. Electroneutral complexes at r(i) = 1 showed a multitude of different complex forms. Fibrillar, network-like and branched structures were frequently present in one complex. Strongly positive charged complexes had a toroidal appearance. All these different forms contributed to the high transfection efficiency. Cellular uptake is supposed to be by phagocytosis.
Subject(s)
DNA/metabolism , Histones/metabolism , Transfection , Animals , Cations/pharmacology , Cattle , DNA/chemistry , DNA/genetics , Histones/chemistry , Histones/genetics , Macromolecular Substances , Microscopy, Atomic Force , Nucleic Acid Conformation , Particle Size , Plasmids/chemistry , Plasmids/genetics , Plasmids/metabolism , Protein Binding , Protein Conformation , Sodium Chloride/pharmacology , Solubility , Transfection/methods , Transfection/standardsABSTRACT
Chronic (low) back pain patients are about to become a main problem of epidemiological and social aspects, especially concerning working conditions. Statistical investigations show rapid progression in application for disability pensions. The author wants to point out that statistical normal phenomena as (low) back pain can no longer be explained by our so-called established handling in reasons, diagnosis and treatment, even not in prophylaxis. Therefore there is a great need for--mainly bio-socio-psychological--studies and efforts concerning etiology, diagnosis and therapeutic concepts of low back pain, especially focussed on working place conditions and disability. In the uplined paper some new concepts are presented and discussed in order to trigger some new points of view and make clear, that further investigations are necessary.
Subject(s)
Disability Evaluation , Low Back Pain/rehabilitation , Germany , Humans , Low Back Pain/diagnosis , Low Back Pain/etiology , Practice Guidelines as TopicABSTRACT
UNLABELLED: Benzodiazepine (BD) misuse and dependence in 80 patients, 1974-1983 undergoing withdrawal treatment, were investigated by means of case histories and catamnestic inquiries. RESULTS: Three fourth of the patients were women. Many of the patients suffered from disturbed matrimonial relations, and 36 lived unmarried, divorced, or widowed. Besides, among the men frequently vocational difficulties were found, which increased in the course of BD-taking. In particular after removal of Lorazepam or Bromazepam in 58 cases withdrawal symptoms appeared, among them seven times delirium and six times epileptic seizures (grand mal). Catamnestic inquiries were practicable in 51 patients. 20 of them had required no further treatment, while 18 took again BD. But only 3 still proved to be as well psychical as physical dependent, in contrast to 14 before withdrawal treatment. Among the 15 only psychical dependent patients 8 merely showed a low dose dependence. Hence BD-dependence proves to be remediable, and subsequently shows only little tendency to relapse.