Fibromyalgia (FM) is characterized by chronic widespread pain, unrefreshing sleep, physical exhaustion, and cognitive difficulties. It occurs in all populations throughout the world, with prevalence between 2% and 4% in general populations. Definition, pathogenesis, diagnosis, and treatment of FM remain points of contention, with some even contesting its existence. The various classification systems according to pain medicine, psychiatry, and neurology (pain disease; persistent somatoform pain disorder; masked depression; somatic symptom disorder; small fiber neuropathy; brain disease) mostly capture only some components of this complex and heterogeneous disorder. The diagnosis can be established in most cases by a general practitioner when the symptoms meet recognized criteria and a somatic disease sufficiently explaining the symptoms is excluded. Evidence-based interdisciplinary guidelines give a strong recommendation for aerobic exercise and cognitive behavioral therapies. Drug therapy is not mandatory. Only a minority of patients experience substantial symptom relief with duloxetine, milnacipran, and pregabalin.

/pdf/facts-and-myths-pertaining-to-fibromyalgia-2gcy5hjyu9.pdf

Facts and myths pertaining to fibromyalgia.

Background: 
Fibromyalgia is a long-term medical condition that is characterised by long-lasting widespread pain throughout the body. TENS is a treatment that involves putting pulsed electrical currents across the surface of the skin using two or four electrodes. It is used to manage painful conditions. TENS is inexpensive, can be self-administered by people with fibromyalgia, and is not associated with any particular side effects. TENS reduces pain during movement so it may be useful in addition to other treatments to help people carry on their normal lives.

Study characteristics: In January 2017, we found eight clinical studies that examined 315 people. We included TENS administered to produce a non-painful 'tingling' sensation at the site of pain either as a treatment alone or combined with exercise treatment. All studies used TENS in comparison with 'fake' (called placebo or sham) TENS, no treatment, or other treatments such as medicine or hydrotherapy (treatment in water).

Key results: We did not find enough high-quality studies to allow us to come to any conclusions about the effectiveness of TENS for fibromyalgia pain. Even though seven studies concluded that TENS relieved pain associated with fibromyalgia, the studies were low quality and the findings for measures of pain were inconsistently reported. Studies did not measure most of our outcomes and it was not always clear what aspects of pain were being reported (e.g. present pain, remembered pain, pain severity, etc.). Only one small pilot study found that one 30-minute treatment of TENS reduced pain on movement during and immediately after treatment; however, there were too few participants observed and it is unknown whether this effect would be maintained over a longer course of TENS treatments. Overall, it is not possible to judge whether TENS reduces pain associated with fibromyalgia. There were no serious side events reported in any of the studies.

Quality of the evidence: We rated the quality of the evidence from studies using four levels: very low, low, moderate, or high. Very low-quality evidence means that we are very uncertain about the results. High-quality evidence means that we are very confident in the results. The quality of the evidence was very low overall because of a lack of data.

/pdf/transcutaneous-electrical-nerve-stimulation-tens-for-1tuhm43wxw.pdf

Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults

OBJECTIVE Fibromyalgia is a poorly understood pain syndrome. Repetitive transcranial magnetic stimulation is a noninvasive brain stimulation therapy and is commonly applied for the management of fibromyalgia. However, controversy regarding its efficacy remains. Therefore, a meta-analysis was conducted to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for fibromyalgia syndrome. METHOD Four medical databases and one physiotherapy database were screened for randomized controlled trials. A systematic review and meta-analysis was performed. Numerical Pain Rating Scale (NPRS), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) anxiety score, Pain Catastrophizing Scale (PCS), Fatigue Severity Scale (FSS), Short Form-36 general health survey mental score, and Fibromyalgia Impact Questionnaire (FIQ) were set as outcome measures. RESULTS Analysis of 14 studies and 433 participants indicated that rTMS exerted more favorable effects on the NPRS than sham rTMS after treatment (standardized mean difference = -0.49, 95% confidence interval = -0.86 to - 0.13, P = 0.008, I2 = 68%) and FIQ (standardized mean difference = -0.50, 95% confidence interval = -0.75 to - 0.25, P = 0.0001, I2 = 28%). However, the BDI, FSS, PCS, mood index, and HADS scores showed no significant difference compared with sham rTMS after treatment. The mean methodological quality of included studies was an acceptable score of 8.5 based on the PEDro scale, suggesting the validity of our conclusions. CONCLUSION This study demonstrated that rTMS relieved pain and enhanced quality of life of patients with fibromyalgia; however, it did not improve anxiety, depression, and other symptoms based on current reports.

Repetitive Transcranial Magnetic Stimulation for Patients with Fibromyalgia: A Systematic Review with Meta-Analysis

Hintergrund
Die planmasige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war fur April 2017 geplant.

[Psychotherapy and psychological procedures for fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles].

The aim of this commentary is to summarize the published Cochrane Review “Aerobic Exercise Training for Adults with Fibromyalgia” by Bidonde et al.,1 (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011336/full) which was developed by the Cochrane Musculoskeletal Group. This Cochrane Cor

Is Aerobic Exercise Training Beneficial for Adults With Fibromyalgia?: A Cochrane Review Summary with Commentary.

Die planmasige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war fur April 2017 geplant. Die Leitlinie wurde unter Koordination der Deutschen Schmerzgesellschaft von dreizehn Fachgesellschaften und zwei Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 42 Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt. Die Literaturrecherche nach systematischen Ubersichtsarbeiten von randomisierten, kontrollierten Studien zur Physiotherapie, Ergotherapie und physikalischen Verfahren erfolgte uber die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstarke erfolgte nach dem Schema des Oxford Centre for Evidence-Based Medicine, Version 2009. Die Formulierung und Graduierung der Empfehlungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Wirksamkeit, Risiken, Patientenpraferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorstanden der beteiligten Fachgesellschaften nach Uberprufung zugestimmt. Ausdauer- und Krafttraining geringer bis mittlerer Intensitat werden stark empfohlen. Chirotherapie, Lasertherapie, Magnetfeldtherapie, Massage und transkranielle Magnetstimulation werden nicht empfohlen.

[Physiotherapy, occupational therapy and physical therapy in fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles].

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. 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. 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.

Physiotherapie, Ergotherapie und physikalische Verfahren beim Fibromyalgiesyndrom. Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten

Die Ubersichtsarbeit gibt auf der Grundlage der uberarbeiteten S2k-Leitlinie Rehabilitation nach traumatischen Frakturen der Brust- und Lendenwirbelsaule ohne neurologische Ausfalle einen aktuellen Uberblick uber eine zielgerichtete Rehabilitation von Patienten mit stabilen bzw. operativ stabil versorgten traumatischen Frakturen an der Brust- und Lendenwirbelsaule. Um eine schnelle soziale und berufliche Wiedereingliederung zu erzielen, soll die Rehabilitation unter Berucksichtigung der Kriterien fur eine ambulante/stationare Rehabilitation hierbei so fruh wie moglich eingeleitet werden. Die Rehabilitations- und Therapieziele sollten sich am biopsychosozialen ICF-Modell der WHO orientieren und mussen vom Team mit dem Patienten abgestimmt werden. Ubergeordnetes Rehabilitationsziel ist die Besserung der funktionalen Gesundheit und Wiederherstellung der ursprunglichen Teilhabefahigkeiten. Aufgrund des individuellen Behandlungsfortschrittes konnen sich Zielsetzungen wahrend der Rehabilitation auch verandern. Schmerztherapeutische Interventionen haben sich an den jeweiligen individuellen Bedurfnissen zu orientieren. Sie sollten multimodal ausgerichtet sein, wobei psychische Kontextfaktoren (Depressivitat, Angst, beruflicher Disstress, passives Schmerzverhalten sowie schmerzbezogene Kognitionen, posttraumatische Belastungsstorung) im Rahmen der Rehabilitation fruhzeitig erfasst und durch psychologisch fundierte bzw. psychotherapeutische Interventionen behandelt werden sollten, da sie zu einer Chronifizierung von Schmerzen beitragen. Der Einsatz einer fruhen funktionell-bewegungsorientierten Therapie wird in der Leitlinie positiv bewertet. Bewegungstherapie wird in der Krankengymnastik, Sporttherapie und einigen Verfahren der Ergotherapie angewandt. Ziel ist u. a. auch die Vermittlung gesundheitsorientierter Verhaltensweisen. Eine orthetische Versorgung von Frakturen der Brust- und Lendenwirbelsaule ist bei stabilen Situationen gemas der Leitlinie i. d. R. nicht notwendig. Um den Behandlungserfolg einer Rehabilitation zu sichern, ist es sinnvoll, bereits wahrend der rehabilitativen Phase Weichen fur die weitere Nachbehandlung zu stellen und vor allem erwerbstatige Patienten in gezielte ambulante Nachsorgeprogramme zu vermitteln.

Rehabilitation after Traumatic Fracture of Thoracic and Lumbar Spine

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[Physiotherapy, occupational therapy and physical therapy in fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles].

Physiotherapie, Ergotherapie und physikalische Verfahren beim Fibromyalgiesyndrom. Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten

Rehabilitation after Traumatic Fracture of Thoracic and Lumbar Spine