Zeitschrift für Rheumatologie
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Fibromyalgia is present in 2% of the general population and leads to impairment by chronic pain and fatigue. It does not improve without therapy directed at the symptoms of fibromyalgia. ⋯ Therapy included information about fibromyalgia, learning of coping strategies, relaxation and endurance training. Our results show that our interdisciplinary group treatment is effective for fibromyalgia and improves anxiety, depression and well being after a period of 5 weeks of in-patient rehabilitation.
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Integration of nociceptive signaling comprises peripheral, spinal, and supraspinal sites of the nervous system. Various excitatory or inhibitory neurotransmitter and--modulator systems participate in pain processing and modulation. Chronic pain states are associated with functional and structural alterations of nociceptive pathways. The numerous dynamic changes in the pharmacologically distinct systems offer novel targets for selective pharmacotherapy.
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Psychosocial distress and psychological abnormality occurs frequently in fibromyalgia patients. Patterns of decreased levels of education, and increased rates of divorce, obesity, and smoking have been noted in clinical and epidemiological studies. Links to physical and sexual abuse have been noted as well. Major depression as well as increased rates of depression, anxiety, and somatization are also commonly found in fibromyalgia.
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Fibromyalgia patients hardly suffer from major psychiatric illnesses. Most often, persistent somatoform pain disorder (ICD-10) and dysthymia are identified by psychiatric assessment. ⋯ Repeated traumatic experiences during childhood and as adults can be discovered in many cases, which helps to understand some of the difficulties met in psychotherapy with FMS patients. Modified psychotherapy techniques are recommended using pain-centered behavioral methods initially, and progressing only later to an insight orientated approach.
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Past research on the phenomenon of enhanced pain sensitivity in fibromyalgia syndrome (FS) revealed evidence for both a higher pain magnitude in response to nociceptive stimuli (hyperalgesia) and a general perceptual amplification of sensations (hypervigilance). In order to distinguish between these two aspects of disturbed sensory processing in FS, cerebral evoked potentials after brief painful laser and auditory stimuli were measured in 10 FS patients. Results were compared with those from age-matched painfree controls. ⋯ Enhanced N1 and P2 amplitudes of LEPs suggest stronger sensory and attentional processing of nociceptive information in FS, respectively. The concept of hypervigilance is challenged by the failure to find differences in auditory perception among FS and control patients. Yet, the importance of unpleasant intensities of auditory stimulation, not applied in this study, to reveal abnormal non-nociceptive perceptual amplification in FS is discussed.