Das Fibromyalgiesyndrom aus der psychosomatischen Perspektive: Ein Überblick

Zusammenfassung

Das Fibromyalgiesyndrom (FMS) wird im psychosomatischen Kontext als stressinduzierte Schmerzerkrankung durch eine Sensibilisierung der zentralnervösen schmerzverarbeitenden Systeme verstanden. Das FMS zeigt hohe Komorbiditäten mit psychischen bzw. psychosomatischen Störungen wie Depression, Angststörungen, somatoformen Störungen und Persönlichkeitsstörungen. Biografisch frühe Stresserfahrungen und Traumatisierungen wie körperlicher oder sexueller Missbrauch in der Kindheit bilden eine Vulnerabilität für die spätere Entwicklung eines FMS. Die Gruppe der FMS-Patient/innen ist hinsichtlich der pathophysiologischen Entstehungswege heterogen, weshalb eine mechanismenbasierte Differenzierung von Subgruppen sinnvoll erscheint. Typische Teufelskreise der Chronifizierung des FMS werden beschrieben und die Wichtigkeit einer gelingenden Arzt-Patient/in-Beziehung herausgestellt. Schwergegradgestuftes Vorgehen und Kommunikationsstrategien werden am Fallbeispiel dargestellt.

Abstract

The psychosomatic approach conceptualises the fibromyalgia syndrome (FMS) as a stress-induced pain syndrome with central sentisitation of pain processing systems. FMS is often comorbid with mental or psychosomatic disorders, such as depression, anxiety disorders, somatoform disorders and personality disorders. Early stress and traumatisation lead to vulnerability to subsequent development of FMS. The group of FMS patients is heterogeneous with regard to pathophysiological pathways, which is why mechanism-based differentiation of subgroups seems to be appropriate. Typical vicious circles of chronification of FMS are described and the importance of a successful doctor-patient relationship is emphasised. Different steps of treatment depend on the severity of the disorder and communication strategies are illustrated with a case example.

Schlüsselwörter

Psychosomatik - Chronischer Schmerz - Fibromyalgie-Syndrom

Key words

Psychosomatic - Chronic Pain - fibromyalgia syndrome

Publikationsverlauf

Artikel online veröffentlicht:
23. März 2021

• Literatur

• 1 Wolfe F, Smythe HA, Yunus MB. et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 1990; 33: 160-172
• 2 Wolfe F. New American College of Rheumatology criteria for fibromyalgia: a twenty-year journey. In: John Wiley & Sons, Inc; Hoboken, USA: 2010
• 3 Wolfe F, Clauw DJ, Fitzcharles M-A. et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. The Journal of rheumatology 2011; 38: 1113-1122
• 4 Häuser W, Nothacker M. Methodenreport der Leitlinie 2017 zum Fibromyalgiesyndrom. Der Schmerz 2017; 31: 200-230
• 5 Wolfe F, Brähler E, Hinz A. et al. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis care & research 2013; 65: 777-785
• 6 Häuser W, Hausteiner-Wiehle C, Henningsen P. et al. Prevalence and overlap of somatic symptom disorder, bodily distress syndrome and fibromyalgia syndrome in the German general population: A cross sectional study. J Psychosom Res 2020; 133: 110111
• 7 Sarzi-Puttini P, Giorgi V, Marotto D. et al. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020; 16: 645-660
• 8 Arnold LM, Hudson JI, Keck JrPE. et al. Comorbidity of fibromyalgia and psychiatric disorders. The Journal of clinical psychiatry 2006; 67: 1219-1225
• 9 Fuller-Thomson E, Nimigon-Young J, Brennenstuhl S. Individuals with fibromyalgia and depression: findings from a nationally representative Canadian survey. Rheumatology international 2012; 32: 853-862
• 10 Ebmeier KP, Donaghey C, Steele JD. Recent developments and current controversies in depression. The Lancet 2006; 367: 153-167
• 11 Bijl RV, Ravelli A, Van Zessen G. Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social psychiatry and psychiatric epidemiology 1998; 33: 587-595
• 12 Borchers AT, Gershwin ME. Fibromyalgia: a critical and comprehensive review. Clinical reviews in allergy & immunology 2015; 49: 100-151
• 13 Fries E, Hesse J, Hellhammer J. et al. A new view on hypocortisolism. Psychoneuroendocrinology 2005; 30: 1010-1016
• 14 Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosomatic medicine 2004; 66: 837-844
• 15 McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain 2003; 106: 127-133
• 16 Celiker R, Borman P, Öktem F. et al. Psychological disturbance in fibromyalgia: relation to pain severity. Clinical rheumatology 1997; 16: 179-184
• 17 M Adams L, C Turk D Psychosocial factors and central sensitivity syndromes. Current rheumatology reviews 2015; 11: 96-108
• 18 Fietta P, Manganelli P. Fibromyalgia and psychiatric disorders. Acta Bio-Medica: Atenei Parmensis 2007; 78: 88-95
• 19 Flatten G, Gast U, Hofmann A. et al. S3-Leitlinie: Posttraumatische Belastungsstörung: ICD-10: F43. 1. Trauma & Gewalt 2011; 5: 202-210
• 20 Häuser W, Galek A, Erbslöh-Möller B. et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. PAIN® 2013; 154: 1216-1223
• 21 Asmundson GJ, Katz J. Understanding pain and posttraumatic stress disorder comorbidity: do pathological responses to trauma alter the perception of pain? In: LWW 2008
• 22 Eisenberger NI, Lieberman MD. Why rejection hurts: a common neural alarm system for physical and social pain. Trends in cognitive sciences 2004; 8: 294-300
• 23 Bucourt E, Martaillé V, Mulleman D. et al. Comparison of the Big Five personality traits in fibromyalgia and other rheumatic diseases. Joint Bone Spine 2017; 84: 203-207
• 24 Uguz F, Çiçek E, Salli A. et al. Axis I and Axis II psychiatric disorders in patients with fibromyalgia. General hospital psychiatry 2010; 32: 105-107
• 25 Lundberg G, Anderberg UM, Gerdle B. Personality features in female fibromyalgia syndrome. Journal of Musculoskeletal Pain 2009; 17: 117-130
• 26 Di Tella M, Castelli L. Alexithymia in chronic pain disorders. Current rheumatology reports 2016; 18: 41
• 27 Egle UT, Ecker-Egle M-L, Nickel R. et al. Fibromyalgia as a dysfunction of the central pain and stress response. Psychotherapie, Psychosomatik, medizinische Psychologie 2004; 54: 137-147
• 28 Van Houdenhove B, Egle U, Luyten P. The role of life stress in fibromyalgia. Current rheumatology reports 2005; 7: 365-370
• 29 Egle U, Egloff N, von Känel R. Stressinduzierte Hyperalgesie (SIH) als Folge von emotionaler Deprivation und psychischer Traumatisierung in der Kindheit. Der Schmerz 2016; 30: 526-536
• 30 Egloff N, Cámara RJ, von Känel R. et al. Hypersensitivity and hyperalgesia in somatoform pain disorders. General hospital psychiatry 2014; 36: 284-290
• 31 Basbaum AI, Fields HL. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Annual review of neuroscience 1984; 7: 309-338
• 32 Egloff, Egle, Känel v. Therapie zentralisierter Schmerzstörungen. Praxis 2009; 98: 271-283
• 33 Engel GL. “Psychogenic” pain and the pain-prone patient. The American journal of medicine 1959; 26: 899-918
• 34 Weaver IC, Cervoni N, Champagne FA. et al. Epigenetic programming by maternal behavior. Nature neuroscience 2004; 7: 847-854
• 35 Häuser W, Kosseva M, Üceyler N. et al. Emotional, physical, and sexual abuse in fibromyalgia syndrome: A systematic review with meta-analysis. Arthritis care & research 2011; 63: 808-820
• 36 Davis DA, Luecken LJ, Zautra AJ. Are reports of childhood abuse related to the experience of chronic pain in adulthood?: A meta-analytic review of the literature. The Clinical journal of pain 2005; 21: 398-405
• 37 Egle UT. Handbuch chronischer Schmerz: Grundlagen, Pathogenese, Klinik und Therapie aus bio-psycho-sozialer Sicht; mit 106 Tabellen. Schattauer Verlag; 2003
• 38 Burke NN, Finn DP, McGuire BE. et al. Psychological stress in early life as a predisposing factor for the development of chronic pain: clinical and preclinical evidence and neurobiological mechanisms. Journal of neuroscience research 2017; 95: 1257-1270
• 39 Schier K, Herke M, Nickel R. et al. Long-term sequelae of emotional parentification: A cross-validation study using sequences of regressions. Journal of Child and Family Studies 2015; 24: 1307-1321
• 40 Egle UT, Zentgraf B. Mechanismenbezogene statt schulenspezifische psychosomatische Schmerztherapie. Schweizer Zeitschrift für Psychiatrie & Neurologie 2009; 3: 18-23
• 41 Marion Lee M, Sanford Silverman M, Hans Hansen M. et al. A comprehensive review of opioid-induced hyperalgesia. Pain physician 2011; 14: 145-161
• 42 Jennings EM, Okine BN, Roche M. et al. Stress-induced hyperalgesia. Progress in neurobiology 2014; 121: 1-18
• 43 Egle U, Egloff N, von Känel R. Stress-induced hyperalgesia (SIH) as a consequence of emotional deprivation and psychosocial traumatization in childhood: implications for the treatment of chronic pain. Schmerz (Berlin, Germany) 2016; 30: 526-536
• 44 Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. Journal of psychiatric research 1990; 24: 323-334
• 45 Leeuw M, Goossens ME, Linton SJ. et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of behavioral medicine 2007; 30: 77-94
• 46 Roenneberg C, Hausteiner-Wiehle C, Henningsen P. „Funktionelle Körperbeschwerden“: Klinisch relevante Leitlinien-Empfehlungen. PSYCH up2date 2020; 14: 35-53
• 47 Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical care 2003; 41: 1284-1292
• 48 Lahmann C, Gündel H, Schneider G. Psychodynamisch-interaktionelle Kurzzeittherapie somatoformer Störungen nach dem PISO-Konzept. PiD-Psychotherapie im Dialog 2012; 13: 71-75
• 49 Egle UT, Zentgraf B. Psychosomatische Schmerztherapie: Grundlagen, Diagnostik, Therapie und Begutachtung. Kohlhammer; Verlag: 2020