Fibromyalgia: Schiltenwolf M

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).

Klement A, Häuser W, Brückle W, Eidmann U, Felde E, Herrmann M, Kühn-Becker H, Offenbächer M, Settan M, Schiltenwolf M, von Wachter M, Eich W. · Institut für Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, 06112 Halle. · Schmerz. · Pubmed #18478270 No free full text.

Abstract: BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), 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 strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Patient's information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). CONCLUSIONS: The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.

Schiltenwolf M, Häuser W, Felde E, Flügge C, Häfner R, Settan M, Offenbächer M. · Sektion Schmerztherapie, Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200, 69118 Heidelberg. · Schmerz. · Pubmed #18449569 No free full text.

Abstract: BACKGROUND: A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), 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 strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: Aerobic exercise training is strongly recommended (grade A) and the temporary use of whole body hyperthermia, balneotherapy and spa therapy is recommended (grade B). CONCLUSION: The significance which can be assigned to most of the studies on the various procedures for therapy is restricted due to short study duration (mean 6-12 weeks) and small sample sizes.

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.

Häuser W, Bernardy K, Arnold B, Offenbächer M, Schiltenwolf M. · Klinikum Saarbrücken, Saarbrücken, Germany. · Arthritis Rheum. · Pubmed #19177530 No free full text.

Abstract: OBJECTIVE: To systematically review the efficacy of multicomponent treatment of fibromyalgia syndrome (FMS). METHODS: We screened Medline, PsychINFO, Scopus, and the Cochrane Library (through December 2007), as well as reference sections of original studies, reviews, and evidence-based guidelines. Randomized controlled trials (RCTs) on the multicomponent treatment (at least 1 educational or other psychological therapy with at least 1 exercise therapy) of FMS were analyzed. RESULTS: We included 9 (of 14) RCTs with 1,119 subjects (median treatment time 24 hours) in the meta-analysis. Effects were summarized using standardized mean differences (SMDs) or weighted mean differences (WMDs). There was strong evidence that multicomponent treatment reduces pain (SMD -0.37; 95% confidence interval [95% CI] -0.62, -0.13), fatigue (WMD -0.85; 95% CI -1.50, -0.20), depressive symptoms (SMD -0.67; 95% CI -1.08, -0.26), and limitations to health-related quality of life (HRQOL) (SMD -0.59; 95% CI -0.90, -0.27) and improves self-efficacy pain (SMD 0.54; 95% CI 0.26, 0.82) and physical fitness (SMD 0.30; 95% CI 0.02, 0.57) at posttreatment. There was no evidence of its efficacy on pain, fatigue, sleep disturbances, depressive symptoms, HRQOL, or self-efficacy pain in the long term. There was strong evidence that positive effects on physical fitness (SMD 0.30; 95% CI 0.09, 0.51) can be maintained in the long term (median followup 7 months). CONCLUSIONS: There is strong evidence that multicomponent treatment has beneficial short-term effects on the key symptoms of FMS. Strategies to maintain the benefits of multicomponent treatment in the long term need to be developed.

Wang H, Buchner M, Moser MT, Daniel V, Schiltenwolf M. · Department of Orthopedic Surgery, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. · Clin J Pain. · Pubmed #19158539 No free full text.

Abstract: OBJECTIVE: In this prospective longitudinal clinical study, we evaluated the role of proinflammatory cytokine IL-8 and its clinical relevance in patients with fibromyalgia (FM) who fulfilled clearly defined inclusion and exclusion criteria and underwent a 3-week inpatients multidisciplinary pain therapy. METHODS: IL-8 in sera was measured in 20 patients with FM and 80 healthy participants at 4 fixed time points: at the beginning of the study, at 10 days, 21 days, and 6 months, respectively. Pain intensity, back function, depression, nicotine/alcohol consumption, and medication were assessed in the patient group and correlated with IL-8 levels. RESULTS: Before and during the inpatient therapy, the serum level of IL-8 was significantly higher in patients with FM compared with controls (P<0.001), but did not correlated with pain intensity and medication. Already at T1 there was a significant reduction of IL-8 serum level (P=0.023) in patient group. Six months after multidisciplinary pain therapy, IL-8 serum level in FM patients was still significantly higher than controls (P=0.044) but reduced approximately to normal range and correlated significantly negatively with pain intensity (r=-0.782, P=0.001). Patients with FM had significantly less pain (P<0.001) and better back function (P<0.001) at day 2 than at day 0. In addition, in patients with FM, IL-8 serum level correlated with nicotine consumption (r=0.471, P=0.042). CONCLUSIONS: Our results suggest that IL-8 level contributes in patients with FM whose pain intensity and back function can be improved under influence of multidisciplinary pain therapy without need of an anti-IL-8 therapy.

Wang H, Moser M, Schiltenwolf M, Buchner M. · Department of Orthopaedic Surgery, Ruprecht-Karls-University of Heidelberg, Heidelberg; and SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. · J Rheumatol. · Pubmed #18528959 No free full text.

Abstract: OBJECTIVE: This prospective study examined circulating cytokines in patients with fibromyalgia (FM) over 6 months rather than at only one timepoint, and investigated correlations between serum cytokine concentrations and pain intensity in FM patients receiving multidisciplinary pain therapy. METHODS: Serum concentrations of proinflammatory cytokines interleukin 6 (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-alpha) and antiinflammatory cytokines IL-4 and IL-10 were measured (Bio-Plex system) in 20 FM patients and 80 healthy subjects on admission and 10, 21, and 180 days after initiation of treatment and correlated to pain intensity. RESULTS: On admission, serum levels of IL-8 (p < 0.001) and TNF-alpha (p < 0.001), but not IL-6, were elevated in patients with FM. No significant difference in IL-4 and IL-10 was found between FM patients and controls. High IL-8 levels remained consistent during the followup, but TNF-alpha was already reduced after 10 days and until 6 months after therapy. After 6 months' treatment with multidisciplinary pain therapy, IL-8 and TNF-alpha levels were significantly lower than at the beginning (p < 0.05 for IL-8, p < 0.001 for TNF-alpha). IL-8 but not TNF-alpha serum levels were correlated with pain intensity (r = -0.782, p = 0.001) in FM patients after 6 months' multidisciplinary pain therapy. CONCLUSION: Our results suggest that proinflammatory cytokines TNF-alpha and IL-8 are involved in FM, but they do not apparently provoke the pain of FM directly. Multidisciplinary pain therapy modified the cytokine profile in patients with FM during the observation period.

Diers M, Koeppe C, Yilmaz P, Thieme K, Markela-Lerenc J, Schiltenwolf M, van Ackern K, Flor H. · Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany. · J Clin Neurophysiol. · Pubmed #18469725 No free full text.

Abstract: To determine the presence of perceptual sensitization and related brain responses we examined 15 patients with fibromyalgia syndrome and 15 healthy controls comparable in age and sex. Multichannel EEG recordings and pain ratings were obtained during the presentation of 800 painful electrical intramuscular and intracutaneous stimuli to the left m. erector spinae and the left m. extensor digitorum. The stimulus intensity was adjusted to 50% between pain threshold and tolerance. Detection and pain thresholds were significantly lower in the fibromyalgia syndrome group. Sensitization occurred for both groups during intramuscular stimulation. In the EEG data the fibromyalgia syndrome patients showed higher N80 amplitudes compared with the healthy controls. Arm stimulation and intramuscular stimulation yielded higher N80 and N150 amplitudes compared with intracutaneous stimulation or stimulation of the back. These results indicate lower pain thresholds in the fibromyalgia syndrome patients after electrical stimulation and a higher N80 amplitude both indicative of enhanced sensory processing in this group.

Schiltenwolf M, Eich W, Schmale-Grete R, Häuser W. · Sektion Schmerztherapie, Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200, 69118 Heidelberg, Deutschland. · Schmerz. · Pubmed #18458961 No free full text.

Abstract: The guidelines aim to provide all professions involved in the treatment of fibromyalgia syndrome (FMS) a systematically developed basis for the diagnosis and therapy of FMS. Diagnostic criteria and empirically founded therapies are presented to reduce the currently insufficient medical care for FMS patients. Recommendations for a stepwise therapeutic approach are designed to improve the quality of medical care, the implementation of effective treatment options as well as reduction of the utilization of non-effective therapies and improvement of the patient-physician relationship. Recommendations on the coordination of medical care (inpatient and outpatient treatment by family physicians, medical specialists and other medical professions, care in emergency and rehabilitation hospitals) aim to reduce rivalry between medical societies and to promote an optimal use of resources. A patient version of the guidelines is aimed at improving patients' knowledge on the etiology and effective treatment options available thus promoting an effective self-management of patients.

Schiltenwolf M. · Sektion Schmerztherapie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Deutschland. · Z Rheumatol. · Pubmed #17849126 No free full text.

Abstract: Persons suffering from chronic musculoskeletal pain and applying for disability claims, should be assessed according to the biopsychosocial disease model. Interdisciplinary guidelines give advice on how to proceed. The claims assessor representing somatic disciplines has to recognize those subjects whose pain is not sufficiently explainable by the extent of physical damage but show typical signs of chronification (generalization of the pain extent, further body complaints, symptoms of depression), to recommend further assessment by a psychiatric or psychosomatic specialist. Technical findings must not be overestimated or the pain complaints of the subjects rejected as deliberate feigning. The extent of the pain and the underlying (physical and psychosocial) disorders have to be assessed by a consistent description of the implications for all areas of life.

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

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