Der Schmerz
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Fibromyalgia poses a challenge for therapy. Mainly comorbid depression has a negative impact on symptoms and impairment in patients with fibromyalgia. This paper gives a systematic overview of how depressiveness affects physical and psychological impairment, coping with disease and rehabilitation outcome among patients with fibromyalgia. The databases PubMed, Embase and PsychINFO were searched for studies published up to April 2010. ⋯ Fibromyalgia patients with depressive symptoms show more sleep disturbances, sexual dysfunction, loss of physical function level and lower quality of life. Patients with fibromyalgia and comorbid depression showed poorer outcomes of multimodal rehabilitation than patients with fibromyalgia without depression. Therefore the assessment of depression should be included in the routine diagnostics of fibromyalgia. Furthermore, patients with fibromyalgia and comorbid depression should be motivated to seek therapy and get better support in coping with depression.
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In 2009, the German version of ICD-10 (ICD-10 GM version 2009) introduced the diagnosis of "chronic pain disorder with somatic and psychological factors", because current ICD-10 diagnoses did not address the biopsychosocial character of chronic pain adequately. For most patients, a dichotomous classification into psychologically versus biomedically caused pain is inappropriate and does not reflect current knowledge on pain. The new code F45.41 addresses the relevance of psychological factors for chronic pain persistence and chronic pain treatment, even in those conditions with a clear biomedical cause at the beginning. ⋯ The distinction of this new diagnosis from other pain-associated diagnoses and recommendations for the coding of comorbid conditions are presented. The differentiation of everyday pain symptoms from pain disorders is outlined. Finally, contextual factors of the classification process, as well as problems in integrating this new diagnosis into diagnosis-related group (DRG) systems of financial reimbursement are discussed.
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The aim of this study was to investigate how sex differences affect psychological measures and coping with pain of patients with fibromyalgia. Gender differences in pain coping strategies would require different gender-specific interventions. ⋯ No gender differences were found in pain measures. Differences were found regarding psychological measures and coping strategies. Women showed more psychological strains and used more adaptive coping strategies on the scales "cognitive restructuring", "perceived self-competence", "mental diversion" and "counterbalancing activities" than men. This implies that women need more treatment for psychological aspects and men need assistance in pain management.
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Biofeedback is a direct feedback of a physiological function. The aim of biofeedback is to change the physiological function into a required direction. To manage this, the physiological function has to be fed back visually or acoustically and it has to be perceived consciously. ⋯ Biofeedback has proved to be successful in non-medical treatment of pain. According to more recent meta-analyses biofeedback reveals high evidence in the treatment of migraine or tension-type headache. In these headaches biofeedback procedures are considered highly effective.