Verhaltensmedizinische Behandlungsstrategien der Fibromyalgie: Review

Zusammenfassung

Das zunehmend bessere Verständnis des Phänomens Schmerz ist mit der Entwicklung zahlreicher neuer medizinisch-somatischer sowie verhaltensmedizinischer Interventionen einhergegangen. Die vorliegende Arbeit gibt einen Überblick über aktuelle ätiopathogenetische Erkenntnisse des Fibromyalgie-Syndroms, die auf der Basis des „Dynamischen Prozessmodells der Fibromyalgie” im Zusammenhang betrachtet werden. Neben zentralnervösen, autonomen und endokrinen Einflussfaktoren auf die Ätiopathogenese der Fibromyalgie wird die Rolle von operanten und kognitiven Lernprozessen bei der Aufrechterhaltung und Verstärkung der Erkrankung aufgezeigt. Im 2. Teil der Arbeit werden verschiedene standardisierte psychologische Therapieformen der Rheumatologie, wie Patientenschulung, Biofeedback, operant- und kognitiv-verhaltenstherapeutische Schmerztherapie, vorgestellt. Erste Studien zu Indikationskriterien der verschiedenen psychologischen Schmerztherapien weisen auf die Individualisierung verhaltensmedizinischer Behandlungsstrategien hin. Metaanalysen weisen die Rolle und die Bedeutsamkeit der psychologischen Schmerztherapie innerhalb eines interdisziplinären Therapieansatzes nach und fordern einen stärkeren Einsatz dieser hocheffektiven psychologischen Therapiemethoden in der rheumatologischen Langzeitbehandlung.

Abstract

Chronic pain is a complex perceptual construct that includes psychosocial and behavioral as well as physiological parameters. The present article reviews the current understanding of etiology and pathogenesis of the specific chronic pain syndrome of fibromyalgia. An integrated dynamic processing model of the fibromyalgia syndrome (FMS) is described incorporating its current understanding. The model integrates neurobiological factors with the role of operant and cognitive behavioral learning principles. The dynamic process model provides a heuristic explanation for the maintenance and reinforcement of the symptoms and disability associated with FMS. The application and utility of patient education, biofeedback, operant- and cognitive behavioral pain treatment are described. Evidence that describes the potential of matching specific treatments to patient characteristics is discussed. The results of meta-analyses demonstrate the role and the relevance of the psychological pain treatment of FMS sufferers and suggest interdisciplinary treatments that incorporate psychological treatments with information and physical exercise are more effective than medical treatments alone.

Schlüsselwörter

Fibromyalgie - Schmerztherapie - Verhaltensmedizin

Key words

Fibromyalgia - pain therapy - behavioral therapy

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