Fibromyalgia: Henningsen P

Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P. · Abteilung Innere Medizin II, Universitatsklinikum Heidelberg, Heidelberg. · Z Rheumatol. · Pubmed #19050952 No free full text.

Abstract: BACKGROUND: Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. METHODS: A systematic literature search was performed in the Cochrane Library (1993-12/2006). Medline (1980-2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Center for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: CWP is defined by the criteria of the American College of Rheumatology (ACR-strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P. · Abteilung Innere Medizin II (Allgemeine Klinische und Psychosomatische Medizin), Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69210, Heidelberg. · Schmerz. · Pubmed #18478271 No free full text.

Abstract: BACKGROUND: Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. METHODS: A systematic literature search was performed in the Cochrane Library (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: CWP is defined by the criteria of the American College of Rheumatology (ACR--strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

Henningsen P, Zipfel S, Herzog W. · Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Langerstrasse 3, 81675 Munich, Germany. · Lancet. · Pubmed #17368156 No free full text.

Abstract: Although functional somatic syndromes (FSS) show substantial overlap, treatment research is mostly confined to single syndromes, with a lack of valid and generally accepted diagnostic criteria across medical specialties. Here, we review management for the full variety of FSS, drawn from systematic reviews and meta-analyses since 2001, and give recommendations for a stepped care approach that differentiates between uncomplicated and complicated FSS. Non-pharmacological treatments involving active participation of patients, such as exercise and psychotherapy, seem to be more effective than those that involve passive physical measures, including injections and operations. Pharmacological agents with CNS action seem to be more consistently effective than drugs aiming at restoration of peripheral physiological dysfunction. A balance between biomedical, organ-oriented, and cognitive interpersonal approaches is most appropriate at this truly psychosomatic interface. In view of the iatrogenic component in the maintenance of FSS, doctor-centred interventions and close observation of the doctor-patient relationship are of particular importance.

Henningsen P, Derra C, Türp JC, Häuser W. · Psychosomatische Klinik, Universitätsklinikum Heidelberg. · Schmerz. · Pubmed #15067534 No free full text.

Abstract: Currently it is unclear whether functional somatic syndromes can be explained by one common underlying functional syndrome. In any case it does not seem justified to view functional somatic syndromes as purely psychological disorders (somatized anxiety or depression). Psychiatric comorbidity and life time stress including traumatisations are mainly, but not exclusively responsible for triggering health care utilisation. The lowered pain threshold that can be demonstrated clinically and experimentally in fibromyalgia, irritable bowel syndrome, tension headache and temporomandibular disorders is currently seen primarily as result of an altered central nervous processing of nociceptive input. In addition some results also hint at a disturbance in the hypothalamus-pituitary-adrenal axis. The predominance of female patients can be due to gender specific illness behaviour as well as to estrogen-induced changes in pain sensitivity. In sum, functional somatic syndromes currently are best explained by a biopsychosocial model of predisposing, triggering and maintaining factors. More research is needed particularly to clarify the role of genetic and of cultural factors.

Häuser W, Eich W, Herrmann M, Nutzinger DO, Schiltenwolf M, Henningsen P. · Interdisziplinäres Zentrum für Schmerztherapie, Innere Medizin I, Klinikum Saarbrücken gGmbH, 66119 Saarbrücken, Germany. · Dtsch Arztebl Int. · Pubmed #19623319 links to  free full text

Abstract: BACKGROUND: This S3 guideline takes positions on currently contentious issues in the classification and treatment of fibromyalgia syndrome (FMS). METHODS: A panel of experts from 10 specialist societies and patients belonging to 2 patient self-help organizations reviewed a total of approximately 8000 publications. Recommendations were developed according to the suggested procedure for S3 guidelines and were then reviewed and approved by the boards of the participating specialist societies. The steering committee ensured that the literature review and the recommendations were kept up to date. RESULTS: Because this disorder is defined by its symptoms and signs, rather than by any consistently identifiable bodily lesion, the term "fibromyalgia syndrome" is a more appropriate designation for it than "fibromyalgia." FMS is defined by the criteria of the American College of Rheumatology and is classified as a functional somatic syndrome. FMS is diagnosed from the typical constellation of symptoms and by the exclusion of inflammatory and metabolic diseases that could cause the same symptoms. A stepwise treatment approach in which the patient and the physician decide jointly on the treatment options is recommended. The most strongly recommended forms of treatment are aerobic exercise, amitriptyline, cognitive behavioral therapy, and spa therapy. CONCLUSIONS: The guideline recommendations are intended to promote more effective treatment of this disorder.

Valet M, Gündel H, Sprenger T, Sorg C, Mühlau M, Zimmer C, Henningsen P, Tölle TR. · Neurologische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. · Psychosom Med. · Pubmed #19073757 No free full text.

Abstract: OBJECTIVE: To investigate whether the functional changes in pain disorder might be reflected by structural brain changes. Pain disorder assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria is characterized by persistent and distressing chronic pain at one or more body sites which cannot be fully explained by a physiological process or somatic disorder. Psychological factors are thought to play a major role. Recent neuroimaging studies evidenced altered pain processing in patients suffering from this disorder. METHODS: Fourteen right-handed women fulfilling the DSM-IV criteria for pain disorder and 25 healthy age-matched women were investigated with magnetic resonance imaging. In the voxel-based morphometry analysis, we compared both groups for changes of gray-matter density. We included age and Beck Depression Inventory scores as nuisance variables to minimize possible confounding effects of age or depressive comorbidity. RESULTS: In the patient group, we found significant gray-matter decreases in the prefrontal, cingulate, and insular cortex. These regions are known to be critically involved in the modulation of subjective pain experiences. CONCLUSIONS: In the context of similar results in patients with other functional pain syndromes, such as fibromyalgia and chronic back pain, we suggest that structural changes in fronto-limbic brain circuits represent not only an objective marker of these pain syndromes but also constitute a critical pathophysiological element. These findings represent a further proof of the important role of central changes in pain disorder.

Henningsen P, Zimmermann T, Sattel H. · Department of Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany. · Psychosom Med. · Pubmed #12883101 links to  free full text

Abstract: OBJECTIVE: Our objective was to review and compare, with meta-analytic methods, observational studies on the association of medically unexplained physical symptoms, anxiety, and depression with special emphasis on healthy and organically ill control groups and on different types of symptoms, measures, and illness behavior. METHODS: A search of MEDLINE and PsycLIT/PsycINFO for abstracts from 1980 to April 2001 was performed; principal investigators in the field were contacted and article reference lists were used to retrieve additional relevant articles. Two hundred forty-four studies were included on the basis of consensus ratings if they fulfilled seven of eight inclusion criteria pertaining to diagnostic accuracy and statistical appropriateness. Five hundred twenty-two studies were deferred or excluded. We focused specifically on the four functional somatic syndromes for which there were sufficient numbers for meta-analytic integration: irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD), fibromyalgia (FM), and chronic fatigue syndrome (CFS). Data were extracted independently by two authors according to a prespecified coding manual with up to 70 parameters per study. RESULTS: Effect sizes for the association of the four functional somatic syndromes with depression and anxiety were of moderate magnitude but were highly significant statistically when compared with healthy persons and controls with medical disorders of known organic pathology. Moreover, this association was significant whether depression was measured with or without somatic items. Chronic fatigue syndrome is characterized by higher scores of depression, fibromyalgia by lower scores of anxiety than irritable bowel syndrome. Consulting behavior and severity of somatization is related to higher levels of anxiety and depression. CONCLUSIONS: Meta-analytic integration confirms that the four functional somatic syndromes (IBS, NUD, FM, CFS) are related to (but not fully dependent on) depression and anxiety. At present, there is only limited meta-analytic evidence for the same sort of association for medically unexplained physical symptoms in general. In view of the relative independence from depression and anxiety, classification and treatment of these symptoms and syndromes as "common mental disorders" does not seem fully appropriate.

Schiltenwolf M, Henningsen P. · No affiliation provided · Pain. · Pubmed #17583432 No free full text.

This publication has no abstract.