V. Köllner

Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom. Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten

BACKGROUNDnThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.nnnMETHODSnThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42xa0members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0search 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 axa0consensus. 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.nnnRESULTS AND CONCLUSIONnThe 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. Axa0step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.ZusammenfassungHintergrundDie planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.MethodikDie Leitlinie wurde unter Koordination der Deutschen Schmerzgesellschaft von dreizehn Fachgesellschaften und zwei Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 42xa0Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt. Die Literaturrecherche nach systematischen Übersichtsarbeiten von randomisierten, kontrollierten Studien zu Patientenedukation und partizipativer Entscheidungsfindung erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke 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, Patientenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.Ergebnisse und SchlussfolgerungDie Diagnose eines Fibromyalgiesyndroms (FMS) soll dem Betroffenen explizit mitgeteilt werden. Eine gemeinsame Entscheidungsfindung mit den Betroffenen über Therapieoptionen sollte auf der Basis ihrer Präferenzen und Begleiterkrankungen sowie des Ansprechens auf bisherige Therapien durchgeführt werden. Eine stufenweise Behandlung in Abhängigkeit vom Schweregrad des FMS und dem Ansprechen auf Therapiemaßnahmen wird empfohlen.AbstractBackgroundThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.MethodsThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42xa0members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0search 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 axa0consensus. 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 conclusionThe 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. Axa0step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.

Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom

BACKGROUNDnThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.nnnMETHODSnThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42xa0members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0search 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 axa0consensus. 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.nnnRESULTS AND CONCLUSIONnThe 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. Axa0step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.ZusammenfassungHintergrundDie planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.MethodikDie Leitlinie wurde unter Koordination der Deutschen Schmerzgesellschaft von dreizehn Fachgesellschaften und zwei Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 42xa0Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt. Die Literaturrecherche nach systematischen Übersichtsarbeiten von randomisierten, kontrollierten Studien zu Patientenedukation und partizipativer Entscheidungsfindung erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke 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, Patientenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.Ergebnisse und SchlussfolgerungDie Diagnose eines Fibromyalgiesyndroms (FMS) soll dem Betroffenen explizit mitgeteilt werden. Eine gemeinsame Entscheidungsfindung mit den Betroffenen über Therapieoptionen sollte auf der Basis ihrer Präferenzen und Begleiterkrankungen sowie des Ansprechens auf bisherige Therapien durchgeführt werden. Eine stufenweise Behandlung in Abhängigkeit vom Schweregrad des FMS und dem Ansprechen auf Therapiemaßnahmen wird empfohlen.AbstractBackgroundThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.MethodsThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42xa0members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0search 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 axa0consensus. 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 conclusionThe 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. Axa0step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.

Internetbasierte Untersuchungen zur diagnostischen Klassifikation und Kodierung psychischer Störungen im Vergleich von ICD-11 und ICD-10

The German Society for Psychiatry, Psychosomatics and Psychotherapy (DGPPN,) conducted a comprehensive field study (principal investigator WG) funded by the German Federal Ministry of Health in cooperation with 4 other German medical societies in the field of mental health (DGPM, DGPPR, DeGFS, DGfS) * to support WHOs development of the ICD-11 (Chapters 6 and 17). The objective of the web-based field study was to compare ICD-10 and ICD-11 (beta draft) for selected mental disorders, regarding consistency, accuracy and assessment of utility. The first study (TP1) focused on the diagnostic classification and the second (TP2) on assignment of diagnostic codes.In TP1, clinicians used either the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG) version or a draft version of the ICD-11 CDDG to evaluate 10 case vignettes in a randomized study implemented through the WHO GCPN **. As hypothesized, consistency was in favor of the ICD-11 (p = .02; n = 319 expert participants) though there was some variability across the different diagnostic categories. In addition, time for diagnosis was shorter (p = .01) and clinicians judgment of utility (ease of use; goodness of fit) was better for ICD-11 (p = .047 and p < .001 respectively).TP2 focused on consistency of diagnostic code assignment for 25 short case descriptions (including explicit diagnosis and additional clinical information) using both ICD-10 and ICD-11 in a randomized web-based field study which was run on the WHO ICD-FiT *** platform. Based on 531 code assignments by120 expert clinicians, consistency for ICD-11 was significantly lower compared to ICD-10 (71 % vs. 82 %, p < .001) contrary to study hypothesis, and time required was significantly higher for ICD-11 (p < .001). Nevertheless, utility assessments were in favor of ICD-11 (p < .005).In summary, in TP1, given vignettes with more complex clinical descriptions more similar to clinical cases, ICD-11 showed advantages in the consistency of correct diagnoses among clinicians, time required to reach a diagnosis, and clinicians ratings of clinical utility. These results provide evidence for quality improvement of the diagnostic process due to the revision of the more complete diagnostic guidelines for ICD-11. In the coding task of TP2, coding by clinicians using the ICD-10 was more consistent and faster than coding using the ICD-11. This may be a result of the greater complexity for coding use of the ICD-11 (e. g., due to post-coordination), as well as greater familiarity with the ICD-10 system (which German clinicians currently use) and lack of practice with the new ICD-11 codes and tools. In spite of this, users assessed the ICD-11 system as more useful than the ICD-10, in part also because of ICD-11s more systematic and comprehensive coding tools. In addition, time needed for coding improved with practice, indicating need for intense education and training initiatives when ICD-11 is adopted and implemented into clinical practice.

Neglect-like-Symptome bei Operationen an der oberen Extremität

ZusammenfassungHintergrundNeglect-like-Symptome (NLS) beschreiben das Erleben einer Extremität als fremdartig und wurden bei chronischen Schmerzerkrankungen sowie nach Kniegelenkersatz nachgewiesen. Ziel der vorliegenden Arbeit war es herauszufinden, ob Patienten mit und ohne NLS nach operativen Eingriffen an der oberen Extremität bezüglich Schmerzstärke und psychosozialer Variablen differieren und ob NLS bei chronifiziertem postoperativem Schmerz (CPSP) gehäuft auftreten.Methodik241xa0Patienten wurden präoperativ, einen Tag, 4xa0Wochen, 3xa0und 6xa0Monate postoperativ mit validierten Fragebögen untersucht. Patienten mit und ohne NLS wurden miteinander verglichen (χ2-Test, Mann-Whitney-U-Test). Das Signifikanzniveau wurde für multiples Testen adjustiert.ErgebnisseNLS traten in geringer Ausprägung im gesamten Beobachtungszeitraum auf. Patienten mit NLS wiesen zu allen Messzeitpunkten signifikant höhere Maximalschmerzwerte (mittlerer Unterschied [∆]xa0= 3; adjustiertes pxa0< 0,005), eine stärkere Beeinträchtigung durch den Schmerz (∆xa0= 15; adjustiertes pxa0<xa00,001), mehr Angst (∆xa0= 3; adjustiertes pxa0< 0,005), Depression (∆xa0= 3; mittleres adjustiertes pxa0= 0,003) und Bewegungsangst (∆xa0= 4; präoperativ n.u2009s.; postoperativ mittleres adjustiertes pxa0= 0,004) auf. Präoperativ gaben sie mehr „stressful life events“ (pxa0= 0,002) und höhere Stresswerte (pxa0< 0,001) an. Bei CPSP traten NLS signifikant häufiger auf (74u2009%) als bei Patienten ohne klinisch bedeutsamen Schmerz (17,5u2009%; pxa0< 0,001).SchlussfolgerungNLS scheinen mit höheren Schmerzstärken, stärkerer Beeinträchtigung durch den Schmerz sowie höherer psychosozialer Belastung assoziiert zu sein und treten bei CPSP gehäuft auf. Ob NLS ein unabhängiger Risikofaktor für die Schmerzchronifizierung sind und somit eine eigenständige Rolle in der Pathogenese von Schmerz spielen, muss weiter untersucht werden.AbstractBackgroundNeglect-like symptoms (NLS) describe the experience of perceiving axa0limb as foreign and could be detected in chronic pain disorders as well as after knee joint replacement. The aim of the present study was to find out whether patients with and without NLS after surgery of the upper extremities differ with respect to pain intensity and psychosocial variables and if NLS are associated with chronic postoperative pain (CPSP).MethodsIn this study 241xa0patients were interviewed using a validated questionnaire preoperatively as well as 1 day, 4xa0weeks, 3 months and 6xa0months postoperatively. Patients with and without NLS were compared using the χ2-test or Mann-Whitney U‑test. The level of significance was adjusted for multiple testing.ResultsThe NLS could be found to a slight extent throughout the entire study period. Patients with NLS showed significantly higher maximum pain scores at every measurement time point: average difference (∆xa0= 3, adjusted pxa0< 0.005), axa0higher impairment due to pain (∆xa0= 15, adjusted pxa0< 0.005), more anxiety (∆xa0= 3, adjusted pxa0< 0.005), depression (∆xa0= 3, average adjusted pxa0< 0.003) and kinesiophobia (∆xa0= 4, preoperative not significant, average postoperative adjusted pxa0= 0.004). Preoperatively, more stressful life events (pxa0= 0.002) and higher stress values (pxa0< 0.001) were reported. In patients with CPSP, NLS occurred significantly more often (74%) than in patients without clinically relevant pain (17.5%. pxa0< 0.001).ConclusionThe occurrence of NLS is associated with higher pain scores, more impairment due to pain and axa0higher psychosocial burden and they are more frequent in patients with CPSP. Further investigations are needed to show if NLS are an independent risk factor for the chronification of pain and if NLS play an independent role in the pathogenesis of pain.BACKGROUNDnNeglect-like symptoms (NLS) describe the experience of perceiving axa0limb as foreign and could be detected in chronic pain disorders as well as after knee joint replacement. The aim of the present study was to find out whether patients with and without NLS after surgery of the upper extremities differ with respect to pain intensity and psychosocial variables and if NLS are associated with chronic postoperative pain (CPSP).nnnMETHODSnIn this study 241xa0patients were interviewed using a validated questionnaire preoperatively as well as 1 day, 4xa0weeks, 3 months and 6xa0months postoperatively. Patients with and without NLS were compared using the χ2-test or Mann-Whitney U‑test. The level of significance was adjusted for multiple testing.nnnRESULTSnThe NLS could be found to a slight extent throughout the entire study period. Patients with NLS showed significantly higher maximum pain scores at every measurement time point: average difference (∆xa0= 3, adjusted pxa0< 0.005), axa0higher impairment due to pain (∆xa0= 15, adjusted pxa0< 0.005), more anxiety (∆xa0= 3, adjusted pxa0< 0.005), depression (∆xa0= 3, average adjusted pxa0< 0.003) and kinesiophobia (∆xa0= 4, preoperative not significant, average postoperative adjusted pxa0= 0.004). Preoperatively, more stressful life events (pxa0= 0.002) and higher stress values (pxa0< 0.001) were reported. In patients with CPSP, NLS occurred significantly more often (74%) than in patients without clinically relevant pain (17.5%. pxa0< 0.001).nnnCONCLUSIONnThe occurrence of NLS is associated with higher pain scores, more impairment due to pain and axa0higher psychosocial burden and they are more frequent in patients with CPSP. Further investigations are needed to show if NLS are an independent risk factor for the chronification of pain and if NLS play an independent role in the pathogenesis of pain.

Psychotherapie und psychologische Verfahren beim Fibromyalgiesyndrom

BACKGROUNDnThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.nnnMETHODSnThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0systematic 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 axa0consensus. 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.nnnRESULTS AND CONCLUSIONnCognitive behavioral therapies received axa0strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.ZusammenfassungHintergrundDie planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.MethodikDie 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 Übersichtsarbeiten von randomisierten, kontrollierten Studien von psychologischen und psychotherapeutischen Verfahren erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke 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, Patientenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.Ergebnisse und SchlussfolgerungKognitive Verhaltenstherapien erhielten eine starke, Biofeedback und geleitete Imagination/Hypnose eine schwache Empfehlung.AbstractBackgroundThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.MethodsThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0systematic 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 axa0consensus. 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 conclusionCognitive behavioral therapies received axa0strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.

Neglect-like-Symptome als Prädiktor für höhere postoperative Schmerzwerte und Implikationen für die Praxis

Die Suche nach Faktoren, die den Erfolg einer Therapie bereits zuvor absehen lassen ist in allen Fachrichtungen der Medizin groß. Zur Vorhersage der Schmerzstärke nach Operationen der oberen Extremitäten können möglicherweise Neglect-like-Symptome dienen.

Multimodale Therapie des Fibromyalgiesyndroms Multimodal therapy of fibromyalgia syndrome

BACKGROUNDnThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.nnnMETHODSnThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=xa08) with axa0total of 42xa0members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0search 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 axa0consensus. 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.nnnRESULTS AND CONCLUSIONnThe use of multimodal therapy (combination of aerobic exercise with at least one psychological therapy) with a duration of at least 24u2009h is strongly recommended for patients with severe forms of fibromyalgia.ZusammenfassungHintergrundDie planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.MethodikDie Leitlinie wurde unter Koordination der Deutschen Schmerzgesellschaft von dreizehn Fachgesellschaften und zwei Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 42xa0Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt. Die Literaturrecherche nach systematischen Übersichtsarbeiten von randomisierten, kontrollierten klinischen Studien mit multimodaler Therapie erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke 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, Patientinnenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.Ergebnisse und SchlussfolgerungDer Einsatz von multimodaler Therapie (Kombination von aerobem Training mit mindestens einem psychologischen Verfahren) mit mindestens 24u2009h Therapiedauer wird für Patientinnen mit schwereren Verläufen des FMS stark empfohlen.AbstractBackgroundThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.MethodsThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=xa08) with axa0total of 42xa0members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0search 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 axa0consensus. 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 conclusionThe use of multimodal therapy (combination of aerobic exercise with at least one psychological therapy) with a duration of at least 24u2009h is strongly recommended for patients with severe forms of fibromyalgia.

Psychotherapie und psychologische Verfahren beim Fibromyalgiesyndrom. Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten

BACKGROUNDnThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.nnnMETHODSnThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0systematic 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 axa0consensus. 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.nnnRESULTS AND CONCLUSIONnCognitive behavioral therapies received axa0strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.ZusammenfassungHintergrundDie planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.MethodikDie 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 Übersichtsarbeiten von randomisierten, kontrollierten Studien von psychologischen und psychotherapeutischen Verfahren erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke 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, Patientenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.Ergebnisse und SchlussfolgerungKognitive Verhaltenstherapien erhielten eine starke, Biofeedback und geleitete Imagination/Hypnose eine schwache Empfehlung.AbstractBackgroundThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.MethodsThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0systematic 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 axa0consensus. 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 conclusionCognitive behavioral therapies received axa0strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.

Psychotherapie und psychologische Verfahren beim Fibromyalgiesyndrom@@@Psychotherapy and psychological procedures for fibromyalgia syndrome: Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten@@@Updated guidelines 2017 and overview of systematic review articles

BACKGROUNDnThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.nnnMETHODSnThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0systematic 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 axa0consensus. 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.nnnRESULTS AND CONCLUSIONnCognitive behavioral therapies received axa0strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.ZusammenfassungHintergrundDie planmäßige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war für April 2017 geplant.MethodikDie 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 Übersichtsarbeiten von randomisierten, kontrollierten Studien von psychologischen und psychotherapeutischen Verfahren erfolgte über die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstärke 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, Patientenpräferenzen und Umsetzbarkeit von Therapieverfahren wurden gegeneinander abgewogen. Der Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften nach Überprüfung zugestimmt.Ergebnisse und SchlussfolgerungKognitive Verhaltenstherapien erhielten eine starke, Biofeedback und geleitete Imagination/Hypnose eine schwache Empfehlung.AbstractBackgroundThe regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.MethodsThe guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (nxa0=8) with axa0total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Axa0systematic 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 axa0consensus. 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 conclusionCognitive behavioral therapies received axa0strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.

Spektrum und Häufigkeit von ADHS-Syndromen und Teilleistungsstörungen bei Patienten in der psychosomatischen Rehabilitation

OBJECTIVEnADHD (attention deficit hyperactivity disorders) and MCD (minimal cerebral dysfunctions) can impair participation. They pose difficult diagnostic problems. Aim of the present study has been to describe the frequency and the spectrum of ADHD and MCD in psychosomatic inpatients.nnnMETHODSn1453 psychosomatic inpatients filled in the ADHS-SB and the MCD-TLS-FB screening for self-reported ADHD and minimal cerebral dysfunctions. Prevalence rates were calculated depending on different intensities of symptoms.nnnRESULTSnAccording to the ADHS-SB 49.5% of the patients met the criteria of an adult ADHD when taking all intensities of symptoms into account. The prevalence rate decreases to 14,6% if moderate to severe symptoms and to 1% if only severe symptoms ratings were recognized. Additional to core symptoms of attentions deficit and hyperactivity patients with ADHD reported about problems with orientation, memory, cognition, emotion regulation, vegetative stability and movement.nnnDISCUSSIONnADHD-related symptoms and minimal cerebral dysfunctions are frequently seen in psychosomatic inpatients. In clinical practice the full spectrum of TLS must be taken into account as they all can impair participation depending on context requirements.