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Aktuelle Rheumatologie 2021; 46(03): 281-290
DOI: 10.1055/a-1325-3015
Übersichtsarbeit

Das Fibromyalgiesyndrom aus der psychosomatischen Perspektive: Ein Überblick

The Fibromyalgia Syndrome from a Psychosomatic Perspective: An Overview
Christoph Schilling
1   Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
,
Kerstin Weidner
1   Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
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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


Publication History

Article published online:
23 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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