Thieme K, Turk D C
Institut für Medizinische Psychologie, Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland.
Center for Pain Research on Impact, Measurement and Effectiveness (C-PRIME), Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Schmerz. 2017 Apr;31(2):170-178. doi: 10.1007/s00482-016-0179-5.
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.
本文阐述了纤维肌痛（FM）推荐诊断方法及治疗手段的变化。将国际上主要认可指南的推荐内容与欧洲抗风湿病联盟（EULAR）的最新推荐进行了比较，与其他指南不同的是，EULAR令人惊讶地建议在对所有FM患者进行患者教育后开展体育锻炼。特别对指南与EULAR推荐之间的差异进行了批判性讨论，因为尽管指南中引用的文献相似，但分析得出了不同的推荐。最后，我们尝试预测从现在起10年后患者将如何接受治疗，其中纳入了指南中的知识以及诊断FM异质性的初始方法。基于经验的问题将推动基于机制的治疗方法，而非仅仅对症状做出反应，以应对个体化、以机制为导向的治疗挑战。
