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Fibromyalgia syndrome is classified as a functional somatic syndrome. There are typical but not clearly defined symptom clusters, such as chronic widespread pain, non-restorative sleep, and a tendency to physical and/or mental exhaustion. The core principle of treatment in the S3 guidelines is a multimodal treatment, especially for severe forms of the disease. Complementary, naturopathic and integrative forms of treatment have an established place in the guidelines. Strong treatment recommendations with a high consensus exist for endurance, weight and functional training. Meditative forms of movement, such as yoga or qigong should also be used. In addition to a lack of physical activity, obesity is also accepted as an associated lifestyle factor and addressed in nutritional therapy and regulation therapy. The central aim is the activation and rediscovery of self-efficacy. Heat applications, such as warm baths/showers, saunas, infrared cabins or exercise in warm thermal water are in accordance with the guidelines. A current field of research is whole-body hyperthermia with water-filtered infrared A radiation. Other self-help strategies are dry brushing according to Kneipp or massaging with rosemary oil, mallow oil or the Aconite pain oil. Taking into account the patients preference, phytotherapeutic agents can also be used as herbal pain treatment (ash bark/trembling poplar bark/goldenrod herb), for sleep disorders in the form of sleep-inducing wraps (lavender heart compress) and internally (valerian, lavender oil capsules, lemon balm). Acupuncture treatment (either ear or body acupuncture) are accepted as part of a multimodal concept. The Clinic for Integrative Medicine and Naturopathy at the Hospital in Bamberg offers the three different formats of inpatient, day clinic and outpatient service covered by the health insurance., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Fibromyalgia is a chronic disease of unknown origin characterized by widespread pain, fatigue, disordered sleep and joint stiffness among other symptoms., Objective: To compare outcomes of manual lymph drainage and myofascial therapy in patients with fibromyalgia., Methods: This was a systematic review. The databases PubMed/MEDLINE, CINAHL, SCOPUS, ScieLo, PEDro, Dialnet, Web of Science, and Elsevier were searched for articles in English or Spanish examining the efficacy of myofascial therapy and/or manual lymph drainage to treat fibromyalgia. Of 356 articles extracted, sixteen articles and one doctoral thesis fulfilled the criteria established for inclusion., Results: The methodological quality of the studies reported in the articles was good (PEDro score 7.49 ± 1.47). The studies included compared different treatments with lymph drainage and/or myofascial therapy. Outcomes indicated improved quality of life for both therapies in all the studies., Conclusions: Myofascial therapy and lymph drainage may be effective in patients with fibromyalgia. Further work is needed as the scientific evidence available is still insufficient., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The complexity of the symptoms of fibromyalgia syndrome (FMS) poses a particular challenge for both those affected and those treating persons with the condition. The present study deals with the questions of coping with FMS from the perspective of both those affected and those treating them and their assessment of needs and requirements in terms of health services., Methods: In a qualitative study design, the individual views of 10 FMS patients and 10 healthcare providers were examined. The patients were selected by means of "purposive sampling" and questioned in guideline-based, problem-centred interviews. Evaluation was carried out by means of content analysis., Results: Both FMS patients and healthcare providers noted problems with availability and accessibility of health services. In addition, some patients felt that they were not taken seriously by their healthcare providers. Care providers in turn experienced reservations about the psychosomatic component on the part of patients. Self-initiative seems to be important for a positive approach to living with FMS., Conclusion: Self-help groups and regionally available networks represent important support possibilities, not least with regard to the psychosomatic component of FMS. Improved coordination of care services can be achieved by promoting interdisciplinary networking. Strengthening the self-initiative of patients and promoting the work of self-help groups can help those affected to develop individual coping strategies., (© 2020. The Author(s).)

Background: The concept of chronic overlapping pain conditions (COPC) is relatively unknown in German pain medicine., Aims: Definition, prevalence, shared etiological and pathophysiological mechanisms of COPC. Summary of recommendations of the interdisciplinary S2k guidelines on diagnostics and treatment of endometriosis relevant for pain physicians., Methods: Selective search of literature in PubMed and selection of recommendations of the S2k guidelines on diagnostics and treatment of endometriosis., Results: According to the US National Institutes of Health, COPCs comprise chronic fatigue syndrome, chronic (unspecific) low back pain, chronic tension headache, endometriosis, fibromyalgia syndrome, migraine, painful bladder syndrome, temporomandibular disorder and vulvodynia. Shared etiological factors are family aggregation, childhood adversities and major or traumatic life events. A major shared pathophysiological mechanism is altered processing of stimuli in the central nervous system. Patients with endometriosis should be screened for other chronic pain conditions and psychological distress. The physical examination should check for local (myofascial trigger points) and generalized signs of hyperalgesia and allodynia indicating central sensitization. In cases of endometriosis with COPCs repeated surgery for pain relief should be avoided. Amitriptyline and duloxetine can be considered as pharmacological treatment options., Discussion: Pain physicians can play a role in the management of patients with endometriosis and COPCs. A multimodal therapy should include physiotherapy and pain-related psychological treatment and possibly centrally acting pain modulation medication.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was planned for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n = 8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest., Results: A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of therapies available were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Conclusion: The guidelines are published in several forms, i.e. complete and short scientific versions and clinical practice and patient versions.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews of randomized controlled trials of complementary and alternative therapies from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was formed by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: Meditative movement therapies (e.g. qi gong, tai chi and yoga) are strongly recommended. Acupuncture and weight reduction in cases of obesity can be considered.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized, controlled trials on patient education and shared decision-making from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences, clinical and practical applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: The diagnosis of fibromyalgia syndrome should be explicitly communicated to the affected individual. Shared decision-making with the patient on the therapeutic options based on individual preferences of the patient, comorbidities and the success of previous treatment is recommended. A step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.

Background: The impact of conflicts of interest (COI) in general and of academic COI in particular on guideline recommendations in pain medicine has not yet been studied. Whether the inclusion of patients and of representatives of all relevant healthcare professions into a guidelines group is protective against a systematic bias of decisions of a guidelines group is currently unknown., Methods: All members of the guidelines group declared their COI before the consensus conferences by a standard form according to the rules and standards of the Association of the German Medical and Scientific Societies. The acceptance or rejection and the strength of consensus of recommendations of the second update of the interdisciplinary guidelines on fibromyalgia syndrome was analyzed twice by first including and then excluding the votes of the guideline group members with COI related to a recommendation from the results of anonymous voting via an internet platform., Results: A total of 42 persons from different healthcare professions and patients participated in the online voting on recommendations. Of the participants 29% had no COI according to the predefined criteria, 53% met the criteria of academic and 33% the criteria of financial COI. In the case of exclusion of participants with a COI related to a specific recommendation, 2 out of 23 recommendations (homeopathy, tramadol) were not accepted. In all votes, there were more participants without COI than with COI., Conclusion: Academic COI were more frequent than financial COI in the second update of the German interdisciplinary guidelines group on fibromyalgia syndrome. The impact of COI on guideline recommendations was low. The inclusion of patients and of all relevant healthcare professionals into a guidelines group is a protective factor against the influence of COI on guideline recommendations.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A literature search for systematic reviews of randomized, controlled trials on physiotherapy, occupational therapy and physical therapy from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: Low to moderate intensity endurance and strength training are strongly recommended. Chiropractic, laser therapy, magnetic field therapy, massage and transcranial magnetic stimulation are not recommended.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature for systematic reviews of randomized, controlled studies on psychological and psychotherapeutic procedures from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: Cognitive behavioral therapies received a strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n = 8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized controlled trials of multimodal therapy from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: The use of multimodal therapy (combination of aerobic exercise with at least one psychological therapy) with a duration of at least 24 h is strongly recommended for patients with severe forms of fibromyalgia.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n = 8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for case series (cross-sectional- and longitudinal studies) for the topics diagnosis, etiology and pathophysiology and for randomised controlled trials (RCT) for treatment modalities from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: No consensus was achieved in the guideline group on whether the diagnostic label "juvenile fibromyalgia" should be used in the management of children and adolescents with chronic widespread pain. There was consensus in the guideline group that antidepressants and anticonvulsants should not be used to treat pain in the so-called juvenile fibromyalgia syndrome.

Background: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017., Methods: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines., Results and Conclusion: The clinical diagnosis of fibromyalgia syndrome can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with examination of tender points) or without the examination of tender points by the modified preliminary diagnostic ACR 2010 or 2011 criteria.

This article elucidates changes in the recommended diagnostics and therapy of fibromyalgia (FM). The recommendations from major internationally recognized guidelines are compared with the newest recommendations of the European League Against Rheumatism (EULAR) that in contrast to the guidelines surprisingly recommend physical exercise after patient education for all FM patients. The differences between the guidelines and the EULAR recommendations are critically discussed in particular because although the literature referred to in the guidelines was similar, the analysis led to different recommendations. Finally, we try to predict how patients will be treated 10 years from now, for which knowledge from the guidelines and the initial approaches that diagnosed heterogeneity in FM are included. Empirically based questions will drive mechanism-based approaches as opposed to simply reacting to symptoms, in order to meet the challenge of an individual, mechanism-oriented treatment.

It is now widely recognized that in many chronic pain syndromes the intensity and severity of individually perceived pain does not correlate consistently with the degree of peripheral nervous system tissue damage or with the intensity of primary afferent or spinal nociceptive neurone activity. In particular, stress and anxiety exert modulatory influences on pain depending on the nature, duration and intensity of the stressor and developmental influences on the maturation of the stress as well as the pain system. In some chronic pain syndromes, e. g. fibromyalgia, TMD or somatoform disorders, no nociceptive or neuropathic input is detectable. We summarise the studies investigating the neural substrates and neurobiological mechanisms of stress-induced hyperalgesia (SIH) in animals and humans. The review provides new perspectives and challenges for the current and future treatment of chronic pain.

Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.

Background and Objectives: The association between attachment style and subjective pain is controversially discussed and the influence of attachment styles on cytokine levels in chronic pain has received little attention in research. In this prospective longitudinal clinical study, we evaluated the relationship between cytokines, attachment style and subjective pain intensity as well as pain-related functioning in patients with fibromyalgia (FM) who underwent a 4-week multidisciplinary pain therapy., Materials and Methods: The attachment style was determined in 43 patients with FM using the relationship questionnaire (RQ-2) and subjective pain with the German version of the West Haven-Yale multidimensional pain inventory. Serum levels of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin 8 (IL-8) and the anti-inflammatory cytokines IL-4 and IL-10 were assessed before and after treatment and additionally once only in 18 healthy controls (Bio-Plex system)., Results: Patients with FM syndrome were significantly more often insecurely attached than healthy controls (p = 0.001). Serum levels of TNF-α (p = 0.001) and IL-10 (p = 0.039) were significantly higher in FM patients compared to controls. Attachment was unrelated to IL-4, IL-8, and IL-10 levels. Insecurely attached FM patients had significantly higher levels of TNF-α (p = 0.002). than securely attached patients. Insecurely and securely attached patients did not differ in subjective levels of pain severity, activity or functional interference. Cytokine levels were not correlated with subjective levels of pain severity or functional interference. Multidisciplinary pain therapy significantly reduced cytokine levels, pain severity, anxiety and depression independent of attachment style.

Clinical pathways (CP) are considered to be a tool of clinical process management describing the optimal route for diagnostic and therapeutic medical treatment of a specified patient. Apart from economic aspects CPs can make a contribution to optimization of health quality management as well as to improvement of medical staff and both patient satisfaction and patient safety whereas the feasibility and acceptance of evidence-based medicine guidelines are often found to be low. In order to stimulate critical discussion by offering the opportunity to easily gain first practical experience, a free web-based clinical pathway system for diagnosis and treatment for patients with fibromyalgia syndrome (FMS) will be presented.

Background: The data available on the types of treatment delivered and healthcare costs of fibromyalgia syndrome (FMS) patients in Germany are currently not representative., Material and Methods: The data from all 6,897,846 insured persons of the German statutory health insurance company Barmer Ersatzkasse (BEK) before the fusion with the Gmünder Ersatzkasse (GEK) were analyzed if more than 2 billing cases with the diagnosis M79.7 were found (FMS cases) in the 8 consecutive quarter years of 2007-2008. In these cases the types and costs of out-patient treatment as well as the operation and procedure key (OPS) classification of in-patient treatment in cases of any discharge diagnosis of FMS were analyzed., Results: A diagnosis of FMS was recorded in 14,870 insured persons in out-patient care and in 6130 in-patients from 1(st) January 2008 to 31(st) December 2009. The 1-year prevalence of FMS diagnosis was 19,592 of the patients (0.3%). Non-steroidal agents were prescribed in 48%, weak opioids in 21% and strong opioids in 11% of the out-patients with FMS. Out-patient psychotherapy was conducted in 8% of the FMS cases. In 31% of the cases hospital treatment was carried out of which 14% received multicomponent therapy. The average healthcare costs were 4,331  per year., Conclusion: The data of the BEK document high healthcare costs and treatment which is mainly not in line with the recommendations of the German guidelines on the management of FMS.

Introduction: Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process., Methods: On the bases of the "Cochrane Library" (1993-2006), "Medline" (1980-2006), "PsychInfo" (2006) and "Scopus" (2006) controlled studies and meta-analyses of controlled studies were analyzed., Results: Only few controlled studies were found supporting in part the effectiveness of CAM therapies in the treatment of fibromyalgia syndrome. Due to the lack of information on long term efficacy and cost-effectiveness, only limited recommendations for CAM therapies can be given., Conclusion: Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.

Background: A guideline for the treatment and diagnostic procedures in 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 of evaluated multicomponent therapy 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: Cognitive and operant behavioral therapy is strongly recommended (grade A). Guided imagery/hypnotherapy and written emotional disclosure are recommended (grade B)., Conclusions: Psychotherapeutic programs tailored to FMS subgroups should be developed and tested.

The etiology of fibromyalgia as a chronic disease is still unexplained. This article gives an overview of the newest treatment methods of behavioral medicine of the fibromyalgia syndrome with regard to the state of research of etiology and diagnosis of this disease. Methods such as operant conditioning, cognitive-behavioral approaches, patient education and relaxation methods are discussed.

As has been shown by a number of working groups, primary fibromyalgia syndrome does not represent a single clinical entity. It is possible to distinguish between a subgroup with high pain sensitivity and no associated psychiatric condition, a second subgroup characterized by depression and concomitant pain symptoms associated with fibromyalgia syndrome, and a third group with somatoform pain disorder of the fibromyalgia type. Bland inflammatory processes must be considered as the cause in the first group, while depression is the underlying reason for the development of pain in the second group. In the third group, serious previous or still existing psychological problems or also insufficient coping with illness symptoms must be regarded as the reason for pain chronification. Group 1 benefits from a blocking of the 5-HT3 receptors by means of tropisetron, for example. This not only affects pain chronification but also the inflammatory process itself. Group 2 needs antidepressant treatment, whereas the focus should be on psychotherapy is group 3. Groups 1 and 2 will also profit from multimodal physical treatment programs; to a certain extent this applies to group 3 as well. So-called mixed types require a combination of therapeutic measures.

Question: Do female inpatients with fibromyalgia (FM) differ from healthy women in their nonverbal affective behavior?, Methods: The data culled from 15 interviews with female FM inpatients and 15 interviews with healthy women were analyzed and the analyses of facial expression were subsequently correlated with gaze behavior., Results: FM patients exhibited neither a reduction of total activity of facial expression nor of absolute frequency of primary affects in comparison to healthy subjects who did (also in eye contact) however exhibit a significantly higher proportion of "genuine joy" and lower proportion of "contempt.", Conclusion: The absence of reduced total activity of facial expression is in contrast to the elaborate descriptions of symptoms provided by the patients, but detailed analyses show that elements which stabilize relationships are lacking and that dissociative elements are implanted in the interactions.

Within clinical practice fibromyalgia is diagnosed according to the classification criteria of the American College of Rheumatology. The examination of the tender points is still to be standardized. By using additional diagnostic criteria fibromyalgia changes into a polysymptomatic syndrom with multiple functional and psychic symptoms. The prevalence of FMS is estimated to range between 1,3-4,8% in the general population. Relative hypocortisolism, sensory hypervigilance, adverse life experiences and psychiatric disorders are discussed as main pathophysiological mechanisms. There are no evidence-based guidelines of scientific societies for the management of fibromyalgia available. Patient education, medical training therapy, physical therapy (heat or cold) and relaxation therapy are recommended. There is a moderate evidence for the effectiveness of tricyclic antidepressants and aerobic training. The effectiveness of multicomponent therapy in fibromyalgia is still to be demonstrated.

Objective: Fibromyalgia syndrome (FMS) is a condition of chronic widespread pain. In its process of chronification psychosocial factors play an important role. A multimodal treatment including integrated group therapy has been proved to be effective. Yet little attention has been paid so far to the exact sequence of changes and interrelation between psychosocial factors, functional capacity, and level of pain under integrated group therapy for FMS patients., Methods: One FMS patient was exemplarily monitored with an electronic diary over 13 weeks while undergoing integrated group therapy. On a daily basis we assessed the level of pain, functional capacity, and other disease-related variables (anxiety, depression, quality of sleep, self-efficacy) via visual analog scales. By the means of multivariate time series analysis the timing of changes in psychosocial factors and their effects on perceived functional capacity was identified., Results: Under integrated group therapy all assessed variables gradually changed in the predicted way. Pain, depression, anxiety could be reduced, whereas self-efficacy, quality of sleep, and functional capacity improved. 71% of the variance could be explained by the multiple regression model. Self-efficacy was, beside pain intensity and depression, an important predictor for functional capacity on the same day. High self-efficacy correlated negatively with the level of functional capacity 3 days later., Conclusion: Integrated group therapy proved to be effective. Self-efficacy played an important role regarding the improvement of functional capacity. Depicting the exact timing of changes in the assessed variables helped to detect patterns of influence and indicate directions for further treatment.

The fibromyalgia syndrome (FMS) is a chronic pain condition of the musculoskeletal system defined by criteria of the American College of Rheumatology in 1990. Despite this definition, etiology and pathogenesis of FMS are still unknown, and consequently the therapy aims mainly at relieving symptoms. The favourite hypothesis is a multietiological concept including genetic, central nervous, muscular, and psychological issues. This article focuses on current psychological aspects as to etiology, process of chronification, and therapy of FMS. Regarding etiology there are diverging hypotheses rather than a general agreement, e.g. specific personality traits, traumatic events, psychodynamic explanations on the basis of a depressive conflict, or the subsumption under somatoform disorders. However, psychological aspects are evident to influence the course and treatment of FMS. In the chronification process behavioural aspects like avoidance behaviour with subsequent physical impairment, attitudes towards subjective theories of illness and therapeutic options, social factors like effects on work, interpersonal conditioning, and coping strategies play an important role. Therapeutic options of FMS comprise exercise, drugs, and psychotherapy. An integrated approach combining these options, a sustainable doctor-patient relationship, and a continuous support of the patient seem to be beneficial.

Modern management of fibromyalgia (FM) requires a holistic approach, which includes nonpharmacologic strategies (both exercise and behavioral strategies) and pharmacologic treatment. Despite only partial effects in some patients, tricyclic antidepressants, selective serotonin reuptake inhibitors, nonsteroidal antiinflammatory drugs, analgesics and opioids are in use. The use of antiepileptic drugs and antispasticity agents is mainly supported by anecdotal data. Three other classes of agents are currently thought to have useful potentials. N-methyl-D-aspartate-(NMDA-)mediated neurotransmission may play an important role in mediating wind-up and related phenomena in pain pathways. Recent studies have demonstrated that NMDA receptor antagonists improve pain symptoms in FM. But a poor side effect profile represents a significant problem. Cerebrospinal fluid substance P concentrations are significantly elevated in FM patients, but the analgesic potential of neurokinin-1 (NK1) receptor antagonists did not meet early expectations. Tropisetron, a 5-HT3 receptor antagonist, was tested in a multicenter, double-blind, randomized, placebo-controlled trial including 403 patients. In those receiving 5 mg tropisetron, 39.2% fulfilled the response criterion (pain reduction 35%) as compared to 26.2% in the placebo group (p=0.033). On 10 and 15 mg, the responder rates were smaller and statistically not significant. A total of 78 responders to therapy were followed up for 12 months. After the end of treatment, pain intensity rose within one month in all 4 groups. Patients having received 5 or 10 mg showed a less pronounced increase in pain. In addition, even 12 months after stopping treatment, pain was still markedly below baseline levels in the 5 and 10 mg groups.