Showing papers by "Winfried Häuser published in 2014"

Review of pharmacological therapies in fibromyalgia syndrome

Abstract: This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration.

Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey

Abstract: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses. 2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]). Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.

Long-term opioid use in non-cancer pain.

Abstract: In a representative survey of persons in Germany aged 14 and older, carried out in 2013, 7.4% of respondents met the criteria for disabling chronic non-cancer pain (CNCP) (1). CNCP is associated with high costs, both direct and indirect (2). In Germany, opioid analgesics are often used to treat CNCP over the long term (i.e., for 3 months or longer) (e1). Routine data from German health insurance carriers have revealed an increase in recent years in the short- and long-term prescribing of opioid analgesics to treat CNCP. The number of prescriptions of weak and strong opioid analgesics for longer than three months among BEK insurees who had non-malignant diagnoses rose from 1.9% in 2006 to 2.1% in 2009 (3). In 2000, 5.3% of the insurees of the AOK and KV Hesse insurance carriers who did not have cancer received at least one prescription for an opioid analgesic; in 2010, the comparable figure was 6.9%. Among insurees receiving at least one prescription for an opioid analgesic, the percentage under long-term opioid treatment (>90 days) was 4.3% in 2001 and 7.5% in 2009 (4). The long-term use of opioid analgesics to treat CNCP is controversial in Germany, as in other countries, because of the discrepancy between clinical practice and the extant evidence base (5– 7, e1, e2). Critical attitudes are sometimes said to reflect an “opioid phobia” that can harm both patients and their physicians (e3– e5). On the other hand, recent review articles and editorials from the United States have highlighted a marked rise in opioid prescriptions and in opioid-related deaths, referring to a so-called “opioid epidemic.” The long-term efficacy and safety of opioid analgesics are now being called in question (6, 7, e1). The guideline takes positions on the indications and contraindications for opioid analgesic treatment for 4 weeks or more and the manner in which such treatment should be carried out, based on detailed analysis of the evidence and structured consensus formation. For the basic question of the utility of opioid analgesics in the treatment of chronic pain syndromes, compared to non-opioid drugs and other treatments, the reader is referred to the German S3 guidelines for the treatment of the respective conditions.

[Chronic pain, pain disease, and satisfaction of patients with pain treatment in Germany. Results of a representative population survey]

Abstract: Background There are only few data from representative samples of the general German population on the prevalence of a "pain disease" and on satisfaction with pain therapy of persons with chronic pain available. Methods A cross-sectional survey with people aged ≥ 14 years representative for the German population was conducted in 2013. Measures were obtained for presence of chronic pain (based on the definition of the International Association for the Study of Pain) and for "pain disease" by the presence of disabling pain in the Chronic Pain Grade Questionnaire and increased psychological distress in the Patient Health Questionnaire 4. In case of chronic pain reports, the satisfaction with current pain treatment and current treatment by a pain specialist were assessed. Results Responses were received from 2508 (57.5 %) of the 4360 people contacted. The prevalence of chronic pain was 26.9 % [95 % confidence interval (CI) 25.2-28.6 %]. A total of 7.4 % (95 % CI 5.0-9.9 %) met the criteria for chronic disabling nonmalignant pain, while 2.8 % (95 % CI 2.2-3.4 %) of participants met the criteria of a pain disease. In all, 31.9 % of persons with disabling pain reported current treatment by a pain specialist and 33.1 % of persons with disabling pain were (very) dissatisfied with current pain treatment. Treatment by a pain specialist was associated with higher health care use and lower treatment satisfaction. Conclusion There is a need to improve the care of persons with chronic disabling pain. Whether pain specialist treatment is (cost) effective in chronic disabling pain needs to be examined by longitudinal studies.

Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia

Abstract: Purpose To describe and evaluate somatic symptoms in patients with rheumatoid arthritis (RA) and fibromyalgia, determine the relation between somatization syndromes and fibromyalgia, and evaluate symptom data in light of the Diagnostic and Statistical Manual-5 (DSM-5) criteria for somatic symptom disorder. Methods We administered the Patient Health Questionnaire-15 (PHQ-15), a measure of somatic symptom severity to 6,233 persons with fibromyalgia, RA, and osteoarthritis. PHQ-15 scores of 5, 10, and 15 represent low, medium, and high somatic symptom severity cut-points. A likely somatization syndrome was diagnosed when PHQ-15 score was ≥10. The intensity of fibromyalgia diagnostic symptoms was measured by the polysymptomatic distress (PSD) scale. Results 26.4% of RA patients and 88.9% with fibromyalgia had PHQ-15 scores ≥10 compared with 9.3% in the general population. With each step-wise increase in PHQ-15 category, more abnormal mental and physical health status scores were observed. RA patients satisfying fibromyalgia criteria increased from 1.2% in the PHQ-15 low category to 88.9% in the high category. The sensitivity and specificity of PHQ-15≥10 for fibromyalgia diagnosis was 80.9% and 80.0% (correctly classified = 80.3%) compared with 84.3% and 93.7% (correctly classified = 91.7%) for the PSD scale. 51.4% of fibromyalgia patients and 14.8% with RA had fatigue, sleep or cognitive problems that were severe, continuous, and life-disturbing; and almost all fibromyalgia patients had severe impairments of function and quality of life. Conclusions All patients with fibromyalgia will satisfy the DSM-5 “A” criterion for distressing somatic symptoms, and most would seem to satisfy DSM-5 “B” criterion because symptom impact is life-disturbing or associated with substantial impairment of function and quality of life. But the “B” designation requires special knowledge that symptoms are “disproportionate” or “excessive,” something that is uncertain and controversial. The reliability and validity of DSM-5 criteria in this population is likely to be low.

Efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome: systematic review and meta-analysis.

Abstract: Objective: Toassesstheefficacy,tolerability,andsafetyofhypnosisinadultirritablebowelsyndromebyameta-analysisofrandomizedcontrolledtrials.Methods: StudieswereidentifiedbyaliteraturesearchofthedatabasesAlliedandComplementaryMedicineDatabase,Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Scopus (frominception toJune30,2013). Primaryoutcomeswereadequate symptom relief,global gastrointestinalscore,and safety.Summary relativerisks(RRs)withnumberneededtotreat(NNT)andstandardizedmeandifferences(SMDs)with95%confidenceintervals(95%CIs)werecalculated using random-effects models. Results: Eight randomized controlled trials with a total of 464 patients and a median of8.5 (7Y12) hypnosis sessions over a median of 12 (5Y12) weeks were included into the analysis. At the end of therapy, hypnosis wassuperior to control conditions in producing adequate symptom relief (RR, 1.69 [95% CI = 1.14Y2.51]; NNT, 5 [3Y10]) and in reducingglobal gastrointestinal score (SMD, 0.32 [95% CI = j0.56 to j0.08]). At long-term follow-up, hypnosis was superior to controls inadequatesymptomrelief(RR,2.17[95%CI=1.22Y3.87];NNT,3[2Y10]),butnotinreducingglobalgastrointestinalscore(SMD,j0.57[j1.40to0.26]).One(0.4%)of238patientsinthehypnosisgroupdroppedoutduetoanadverseevent(panicattack).Conclusion: Thismeta-analysis demonstrated that hypnosis was safe and provided long-term adequate symptom relief in 54% of patients with irritablebowel syndrome refractory to conventional therapy. Key words: irritable bowel syndrome, hypnosis, systematic review, meta-analysis.CI = confidence interval; HRQOL = health-related quality life; IBS =irritable bowel syndrome; RCT = randomized controlled trial; RR =relative risk; SD = standard deviation; SDC = Supplemental DigitalContent; SMD = standardized mean difference.

Chronische Schmerzen, Schmerzkrankheit und Zufriedenheit der Betroffenen mit der Schmerzbehandlung in Deutschland

Abstract: Hintergrund Aus Deutschland liegen nur wenige Daten aus der allgemeinen Bevolkerung zur Pravalenz einer Schmerzkrankheit und der Zufriedenheit von Menschen mit chronischen Schmerzen mit der Schmerztherapie vor.

Psychosocial issues in evidence-based guidelines on inflammatory bowel diseases: a review.

Abstract: AIM: To study statements and recommendations on psychosocial issues as presented in international evidence-based guidelines on the management of inflammatory bowel diseases (IBD). METHODS: MEDLINE, guidelines International Network, National Guideline Clearing House and National Institute for Health and Care Excellence were searched from January 2006 to June 30, 2013 for evidence-based guidelines on the management of IBD. RESULTS: The search yielded 364 hits. Thirteen guidelines were included in the review, of which three were prepared in Asia, eight in Europe and two in the United States. Eleven guidelines made statements and recommendations on psychosocial issues. The guidelines were concordant in that mental health disorders and stress do not contribute to the aetiology of IBD, but that they can influence its course. It was recommended that IBD-patients should be screened for psychological distress. If indicated, psychotherapy and/or psychopharmacological therapy should be recommended. IBD-centres should collaborate with mental health care specialists. Tobacco smoking patients with Crohn’s disease should be advised to quit. CONCLUSION: Patients and mental health specialists should be able to participate in future guideline groups to contribute to establishing recommendations on psychosocial issues in IBD. Future guidelines should acknowledge the presence of psychosocial problems in IBD-patients and encourage screening for psychological distress.

Polysymptomatic distress in patients with rheumatoid arthritis: Understanding disproportionate response and its spectrum

Abstract: Objective Fibromyalgia (FM) in rheumatoid arthritis (RA) can cause consternation because symptoms are seen to be out of proportion to physician and laboratory assessments, and composite RA activity scores such as the 28 joint Disease Activity Score, Clinical Disease Activity Index, and Routine Assessment of Patient Index Data 3 (RAPID-3) can yield apparently “wrong” results. We explored the effect of polysymptomatic distress (PSD), a measure of fibromyalgianess and a quantity derived from the American College of Rheumatology 2010 FM diagnostic criteria, to explain the relationship of patient to physician variables. Methods We obtained PSD scores on 300 RA patients prior to ordinary clinical care, and assessed the associations of PSD with tender and swollen joints, physician global estimate of RA activity, pain, Health Assessment Questionnaire score, and composite RA activity measures during routine clinic assessments. Results PSD scores greater than the sample mean (8.8) were associated with increased patient symptoms regardless of the presence or absence of FM, while scores below the mean were associated with better patient outcomes. PSD scores predicted all patient outcomes and less strongly predicted physician outcomes. The discrepancy between patient and physician measures was greatest at low levels of physician-estimated disease activity. Conclusion PSD rather than FM diagnosis more usefully identifies and predicts disproportionate responses. Just as there are patients who lean disproportionately toward greater severity, there are also patients who disproportionately report milder symptoms. Composite measures used to assess RA are flawed, as they confound RA inflammation and patient distress, and more consideration should be given to disaggregated assessments. PSD also appears to be influenced weakly by RA disease activity.

Validation of the Patient-Doctor-Relationship Questionnaire (PDRQ-9) in a representative cross-sectional German population survey.

Abstract: The patient-doctor relationship (PDR) as perceived by the patient is an important concept in primary care and psychotherapy. The PDR Questionnaire (PDRQ-9) provides a brief measure of the therapeutic aspects of the PDR in primary care. We assessed the internal and external validity of the German version of the PDRQ-9 in a representative cross-sectional German population survey that included 2,275 persons aged>=14 years who reported consulting with a primary care physician (PCP). The acceptance of the German version of this questionnaire was good. Confirmatory factor analysis demonstrated that the PRDQ-9 was unidimensional. The internal reliability (Cronbach's ?) of the total score was .95. The corrected item-total correlations were>=.94. The mean satisfaction index of persons with a probable depressive disorder was lower than that of persons without a probable depressive disorder, indicating good discriminative concurrent criterion validity. The correlation coefficient between satisfaction with PDR and satisfaction with pain therapy was r = .51 in 489 persons who reported chronic pain, indicating good convergent validity. Despite the limitation of low variance in the PDRQ-9 total scores, the results indicate that the German version of the PDRQ-9 is a brief questionnaire with good psychometric properties to assess German patients' perceived therapeutic alliance with PCPs in public health research.

[Treatment of non-specific, functional and somatoform bodily complaints].

Abstract: Nicht-spezifische, funktionelle und somatoforme Korperbeschwerden (NFS) sind ein haufiges und oft chronisches Phanomen in der Haus- und Facharztmedizin. Die Patienten sind erheblich in ihrer Lebensqualitat beeintrachtigt, die direkten und indirekten Folgekosten sind hoch. Fur den Arzt bedeutet ihre Behandlung eine Herausforderung, im ungunstigen Falle kann das Verhalten des Arztes den Verlauf negativ beeinflussen. Unter Federfuhrung der beiden Fachverbande fur Psychosomatische Medizin wurde kurzlich eine umfassende, evidenzbasierte und interdisziplinare S3-Leitlinie zum Umgang mit Patienten mit NFS entwickelt. Diese beschreibt die wesentlichen Elemente der arztlichen Grundhaltung und Gesprachsfuhrung sowie des diagnostischen und therapeutischen Vorgehens aufgrund der aktuellen empirischen Befundlage. Der Aufbau einer partnerschaftlichen Arbeitsbeziehung sowie eine symptom- und bewaltigungsorientierte Grundhaltung begunstigen die Behandlung von Patienten mit NFS. Die biopsychosoziale Simultandiagnostik umfasst die Erhebung der Korperbeschwerden plus organischer Basisdiagnostik und von Beginn an eine psychosoziale Basisanamnese, die bei Hinweisen auf psychosoziale Belastungen erweitert wird. Bei leichteren Verlaufen reicht meist die Behandlung durch den Hausarzt, auf der Grundlage therapeutischer Masnahmen aus der psychosomatischen Grundversorgung. Schwerere Verlaufe werden in einem starker strukturierten Setting behandelt, sie bedurfen regelmasiger und beschwerdeunabhangiger Termine und erfordern die Mitarbeit des Patienten in hoherem Mase. Erforderlich ist der koordinierte und kooperative Einsatz weiterer Elemente aus den Bereichen gestufte Aktivierung, Psychotherapie, Entspannungsverfahren sowie ggf. befristete Medikation. Besonders schwere Verlaufe bedurfen einer multimodalen Behandlung, ggf. im (teil-)stationaren Setting.

What is fibromyalgia, how is it diagnosed, and what does it really mean?

Abstract: Frederick Wolfe MD, National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita, Kansas Brian T. Walitt MD MPH, Washington Hospital Center, Washington, DC Winfried Hauser MD, Department of Psychosomatic Medicine and Psychotherapy Technische Universitat Munchen, Munich, Germany and Department Internal Medicine I, Klinikum Saarbrucken, Saarbrucken, Germany Key Indexing Words: Fibromyalgia, criteria, meaning Financial support: None Conflict of interest: Winfried Hauser has received one consulting honorarium by Daiichi-Sankyo and honoraria for educational lectures by Abbott Germany, Eli-Lilly, Janssen-Cilag and Pfizer in the last 5 years. He is the head of the steering committee of the German guideline on FMS. Corresponding author: Frederick Wolfe MD, fwolfe@arthritis-research.org, (316) 686-9195 Editorial Arthritis Care & ResearchDOI 10.1002/acr.22207This article has been accepted for publication and undergone full peer review but has not beenthrough the copyediting, typesetting, pagination and proofreading process which may lead todifferences between this version and the Version of Record. Please cite this article as an‘Accepted Article’, doi: 10.1002/acr.22207© 2013 American College of RheumatologyReceived: Sep 29, 2013; Accepted: Oct 08, 2013

Opioide bei chronischem neuropathischem Schmerz

Abstract: Die Wirksamkeit und Sicherheit der Opioidtherapie bei chronischen neuropathischen Schmerzen (CNS) ist umstritten. In der vorliegenden Publikation wird ein kurzlich erschienenes systematisches Cochrane-Review zur Wirksamkeit, Vertraglichkeit und Sicherheit von Opioiden bei CNS aktualisiert. Bis Oktober 2013 wurden MEDLINE, Scopus und Cochrane Central Register of Controlled Trials (CENTRAL) wie auch die Literaturverzeichnisse von Originalarbeiten und systematischen Ubersichtsbeitragen zu randomisierten, kontrollierten Studien (RCT) mit Opioiden bei CNS durchsucht. Einschluss fanden doppelblinde, randomisierte, placebokontrollierte Studien mit einer Dauer von mindestens 4 Wochen. Mithilfe eines Random-effects-Modells wurde fur kategoriale Daten die absolute Risikoreduktion (RD) und fur kontinuierliche Variablen die standardisierte Mittelwertdifferenz (SMD) berechnet. Insgesamt 12 RCT mit 1192 Teilnehmern wurden eingeschlossen. Als diagnostische Entitaten wurden berucksichtigt: schmerzhafte diabetische Neuropathie (4 Studien), Postzosterneuralgie (3 Studien), Mischformen von polyneuropathischen Schmerzen (2 Studien) sowie lumbale Radikulopathie, Schmerz nach Ruckenmarkverletzungen und Postamputationsschmerz (jeweils eine Studie). Die mittlere Studiendauer betrug 6 Wochen (Spannweite: 4–12 Wochen). In 4 Studien wurde Morphin getestet, in 3 Tramadol, in 2 Oxycodon und in einer Tapentadol. Im Folgenden sind die gepoolten Ergebnisse von Studien mit parallelem oder Cross-over-Design aufgefuhrt: Opioide waren Placebo in der Reduktion der Schmerzintensitat uberlegen: SMD: − 0,64 [95 %-Konfidenzintervall (KI): − 0,81; − 0,46]; p < 0,0001; 11 Studien mit 1040 Teilnehmern. Opioide waren Placebo bezuglich der 50 %igen Schmerzreduktion nicht uberlegen: RD: 0,16 (95 %-KI: − 0,04; 0,35); p = 0,11; eine Studie mit 93 Teilnehmern. In der von den Patienten berichteten starken oder sehr starken Besserung waren Opioide Placebo nicht uberlegen: RD: 0,17 (95 %-KI: − 0,01; 0,36); p = 0,07; eine Studie mit 53 Teilnehmern. In der Verbesserung der korperlichen Funktionsfahigkeit zeigten Opioide eine Uberlegenheit gegenuber Placebo: SMD: − 0,28 (95 %-KI: − 0,43; − 0,13); p < 0,0001; 7 Studien mit 680 Teilnehmern. Unter Opioiden brachen die Patienten die Behandlung seltener wegen fehlender Wirksamkeit ab als unter Placebo: RD: − 0,07 (95 %-KI: − 0,13; − 0,02); p = 0,008; 6 Studien mit 656 Teilnehmern. Wegen unerwunschter Ereignisse brachen sie die Behandlung dagegen haufiger unter Opioiden als unter Placebo ab: RD: 0,08 (95 %-KI: 0,05; 0,12); p < 0,0001; 10 Studien mit 1018 Teilnehmern; „number needed to harm“: 11 (95 %-KI: 8; 17). Hinsichtlich der Haufigkeit schwerer unerwunschter Ereignisse oder Todesfalle fand sich kein signifikanter Unterschied zwischen Opioiden und Placebo. In Kurzzeitstudien (4–12 Wochen) bei CNS waren Opioide Placebo in der Wirksamkeit uberlegen, in ihrer Vertraglichkeit aber unterlegen. Hinsichtlich der Sicherheit ergab sich kein Unterschied. Die Aussage zur Sicherheit von Opioiden bei CNS im Vergleich zu Placebo wird durch die geringe Zahl schwerer unerwunschter Ereignisse und Todesfalle eingeschrankt. Bei ausgewahlten Patienten kann eine Kurzzeittherapie mit Opioiden in Betracht gezogen werden.

Social security work disability and its predictors in patients with fibromyalgia.

Abstract: Objective To determine prevalence and incidence of US Social Security Disability and Supplemental Security Income (SSD) in patients with fibromyalgia and to investigate prediction of SSD. Methods Over a mean of 4 years (range 1–13 years), we studied 2,321 patients with physician-diagnosed fibromyalgia (prevalent cases) and applied modified American College of Rheumatology (ACR) 2010 research criteria to identify criteria-positive patients. Results During the study, 34.8% (95% confidence interval [95% CI] 32.9–36.8%) of fibromyalgia patients received SSD. The annual incidence of SSD among patients not receiving SSD at study enrollment was 3.4% (95% CI 3.0–3.9%), and 25% were estimated to be work disabled at 9.0 years of followup. By comparison, the prevalence of SSD in rheumatoid arthritis (RA) patients with concomitant fibromyalgia was 55.6% (95% CI 54.3–57.0%) and was 42.4% in osteoarthritis (OA). By study conclusion, 31.4% of SSD awardees were no longer receiving SSD. In univariate models, incident SSD in patients with fibromyalgia was predicted by sociodemographic measures and by symptom burden; but the strongest predictor was functional status (Health Assessment Questionnaire disability index [HAQ DI]). In multivariable models, the HAQ DI and the Short Form 36-item health survey physical and mental component summary scores, but no other variables, predicted SSD. Fibromyalgia criteria–positive patients had more SSD, but the continuous scale, polysymptomatic distress index derived from the ACR criteria was a substantially better predictor of SSD than a criteria-positive diagnosis. Conclusion The prevalence of SSD is high in fibromyalgia, but not higher than in RA and OA patients who satisfy fibromyalgia criteria. The best predictors of work disability are functional status variables.

The Impact of Body Weight and Depression on Low Back Pain in a Representative Population Sample

Abstract: Objective Low back pain (LBP), obesity, and depression are highly prevalent health conditions. We assessed the relative impact of body weight and depression on different types of LBP in a representative population sample. Design This is a cross-sectional study. Setting and Patients Two thousand five hundred ten subjects aged 14–90 years were randomly selected from the German general population in 2012. Measures Pain sites and duration of pain were assessed by the Widespread Pain Index( WPI), depression by the Beck Depression Inventory Primary Care Questionnaire, disability by the European Organization for Research and Treatment of Cancer questionnaire, and current body mass index (BMI, kg/m2) by self-reported body weight and height. Widespread pain was defined by ≥7/19 pain sites in the WPI. Hierarchical logistic regression analyses were performed with different types of LBP as the dependent variable, and age, gender, lifetime employment status as a worker, number of pain sites, BMI, and depression as independent variables. Results One thousand six hundred eighty-seven (67.1%) of participants reported no pain. Five hundred six (20.2%) reported chronic LBP and 84 (3.3%) reported disabling chronic LBP. Age (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.04–1.06]), BMI (OR 1.08 [95% CI 1.05.–1.11]), and depression (OR 1.38 [95% CI 1.30–1.49]) independently predicted chronic LPB compared with persons without pain. Age (OR 1.07 [95% CI 1.05–1.09]), BMI (OR 1.07 [95% CI 1.03–1.13]), and depression (OR 1.71 [95% CI 1.55–1.88]) independently predicted disabling chronic LPB compared with persons without pain. Age (OR 1.03 [95% CI 1.01–1.05]), widespread pain (OR 5.23 [95% CI 3.04–9.00), and depression (OR 1.34 [95% CI 1.16–1.55]) independently predicted disabling chronic LPB compared with persons with nondisabling chronic LBP. Conclusion BMI and depression are modifiable risk indicators for chronic disabling LBP.

Fibromyalgia and Physical Trauma: The Concepts We Invent

Abstract: Despite weak to nonexistent evidence regarding the causal association of trauma and fibromyalgia (FM), literature and court testimony continue to point out the association as if it were a strong and true association. The only data that appear unequivocally to support the notion that trauma causes FM are case reports, cases series, and studies that rely on patients’ recall and attribution — very low-quality data that do not constitute scientific evidence. Five research studies have contributed evidence to the FM-trauma association. There is no scientific support for the idea that trauma overall causes FM, and evidence in regard to an effect of motor vehicle accidents on FM is weak or null. In some instances effect may be seen to precede cause. Alternative causal models that propose that trauma causes “stress” that leads to FM are unfalsifiable and unmeasurable.

Complementary and alternative medicine for the treatment of fibromyalgia.

Abstract: The fibromyalgia syndrome (FMS) is a chronic condition characterized by chronic widespread pain, fatigue, cognitive disturbances, sleep disorders, and somatic and psychological distress [1, 2]. Between 2.9 and 3.8% of the general population in Europe and the US are affected [3–5], with 9 times as many women as men in clinical settings [2]. Many patients with fibromyalgia use complementary and alternative therapies to cope with their disease. A recent consumers report indicated that 67.0% of German FMS patients used heat application or thermal baths, 35.2% different CAM medications such as homeopathy, dietary supplements, and vitamins, 34.6% some kind of diet, 28.5% tool-based physical therapies such as acupuncture, and 18.4% meditative exercises such as yoga or tai chi [6]. In summary, almost every FMS patient had used at least one CAM therapy for the management of FMS. In an Internet sample of US American FMS patients, the frequencies were slightly higher [7]. CAM use in FMS patients is associated with younger age, female gender, and higher overall disease burden [8, 9]. Contrary to the frequent use, only limited research has been conducted on complementary and alternative therapies so far. Data on efficacy and safety are however necessary to judge their value within the treatment regimen. Without reliable information, such therapies that might benefit FMS patients will also not be included in standard care; therapies with a negative benefit-risk ratio on the other hand might be applied despite doubts about their effects. This special issue aimed to facilitate publication of research of complementary and alternative therapies for the fibromyalgia syndrome. The papers published in this special issue were carefully selected to display a great variety of different research topics. In the following, a short overview of included papers will be provided. M.-A. Fitzcharles et al. took a closer look at classification and clinical diagnosis of the fibromyalgia syndrome. Three evidence-based interdisciplinary guidelines from Canada, Germany, and Israel were compared in terms of definition and diagnostic procedures, and consistent results have been found for all three guidelines. The results of this review further implied the importance of evidence-based guidelines for health care providers. J. N. Ablin et al. summarized the recommendations of those guidelines with a special emphasis on CAM therapies. While all guidelines supported patient-tailored approaches, recommendations differed, especially regarding CAM. Discrepancies were also present regarding the levels of evidence and the strengths of recommendation. Contrary to Germany and Israel, where some CAM therapies were recommended, no CAM treatment was recommended according to the Canadian guidelines. This supports the need for high-quality research. Three papers reported on clinical trials. In the so-called KAFA-trial, C. S. Kessler et al. investigated the feasibility and efficacy of an additive complex Ayurvedic treatment in 32 FMS patients, using a nonrandomized controlled study design. All patients received conventional care during an inpatient hospital admission with elements of physiotherapy, hydrotherapy, exercise, and cognitive behavioral and occupational therapies. The Ayurvedic group also received individual treatment regimen including massages, diets, yoga, and self-help strategies. At the end of two weeks, different parameters including quality of life, pain, and sleep quality were assessed. A prospective observational trial by K. Kraft et al. with 70 patients tested the effects of vibration massage using a deep oscillation device. Patients were treated twice weekly for five weeks and followed up for two months. Outcomes included safety and tolerability, symptom severity, and quality of life. Finally, J. Sawynok et al. reported the results of an extension trial that investigated 20 FMS patients who had been included in a trial on the effects of qigong for six months. Outcomes included quantitative measures such as pain intensity, disability and quality of life, and qualitative comments of participants. Another four manuscripts reported the results of reviews; one of them was a narrative review and three were systematic reviews, partially with meta-analyses. J. N. Ablin et al. provided a qualitative-narrative review and a historical perspective on the use of spa treatment for fibromyalgia. The authors not only included clinical trials, but also publications regarding the history, the implementation of spa therapy, and related practices in different cultures and provided the readers with a comprehensive overview. Another review by S. S. Nascimento et al. systematically reviewed the efficacy and safety of medicinal plants or related natural products for fibromyalgia. Eight randomized controlled trials were included in this analysis; possible benefits and harms were investigated. R. Lauche et al. aimed to summarize the efficacy and safety of qigong trials. Seven randomized controlled trials with 395 were included and the authors analyzed whether quality of life and other key symptoms were altered by qigong interventions. An established tool to formulate recommendation for clinical practice was also applied. And J. A. Glombiewski et al. conducted a systematic review on EMG and EEG-Biofeedback for FMS. Seven randomized controlled trials were included based on 321 patients. Together these reviews provide up to date information about the state of scientific evidence for the respective topics. The authors are confident that this special issue will provide readers with an insightful cross-section of current FMS research topics and facilitate further high-quality research in the CAM field for the sake of FMS patients. Jost Langhorst Winfried Hauser Romy Lauche Serge Perrot Cayetano Alegre Piercarlo C. Sarzi Puttini

S2k-Leitlinie Divertikelkrankheit/Divertikulitis 1 S2k Guidelines Diverticular Disease/Diverticulitis

Abstract: 1 Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemeinund Viszeralchirurgie (DGAV) in Zusammenarbeit mit Deutsche Gesellschaft für Ernährung (DGE), Deutsche Röntgengesellschaft, Deutsche Gesellschaft für Neurogastroenterologie und Motilität (DGNM), Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM), Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung (DCCV e.V.), AWMF Registernummer 021/20 Inhaltsverzeichnis Seite

Prävalenz beeinträchtigender Bauchschmerzen und Menstruationsbeschwerden

Abstract: Hintergrund Aus Deutschland liegen keine Daten zur Pravalenz von beeintrachtigenden Bauchschmerzen und Menstruationsbeschwerden bei Erwachsenen vor.

Nichtspezifische, funktionelle und somatoforme Körperbeschwerden

Abstract: Mit der S3-Leitlinie „Nicht-spezifische, funktionelle und somatoforme Korperbeschwerden“ wurde erstmals uber psychosoziale und somatische Disziplinen hinweg ein breiter, evidenzbasierter Konsens zu Terminologie und Versorgung erreicht Dieser Beitrag fasst die fur Psychotherapeuten wesentlichen Hintergrundinformationen und Empfehlungen zusammen Bei leichteren Verlaufen reicht meist die Behandlung durch den Hausarzt mit Erarbeiten eines biopsychosozialen Erklarungsmodells und korperlicher/sozialer Aktivierung Schwerere Verlaufe bedurfen eines kooperativen, koordinierten Vorgehens mit regelmasigen/beschwerdeunabhangigen Terminen beim Hausarzt, gestufter Aktivierung und Psychotherapie – v a kognitiv-behaviorale, daneben psychodynamisch-interpersonelle und hypnotherapeutische/imaginative Besonders schwere Verlaufe erfordern eine multimodale, ggf (teil-)stationare Therapie Erganzend wird die fur Betroffene und ihre Angehorigen erarbeitete Patientenleitlinie vorgestellt

Chronic chest pain

Abstract: Hintergrund Im Brustkorb lokalisierte Beschwerden werden von Personen der allgemeinen Bevolkerung haufig angegeben und stellen eine differenzialdiagnostische Herausforderung dar.

Nicht-spezifische, funktionelle und somatoforme Körperbeschwerden – Relevanz für die Schmerzmedizin

Abstract: Mit der S3-Leitlinie „Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Korperbeschwerden (NFS)“ (AWMF Registernr. 051–001) gibt es erstmals einen breiten, evidenzbasierten Konsens uber psychosoziale und somatische Disziplinen hinweg zu Terminologie und Versorgung dieser grosen, gerade in der Schmerzmedizin hochrelevanten Patientengruppe.