背景:纤维肌痛综合征指南的定期更新,AWMF编号145/004,定于2017年4月。
方法:指南由13个科学学会和2个患者自助组织制定,由德国疼痛学会协调。由42名成员组成的工作组(n=8)在性别方面保持平衡,医学专家,在医学或科学等级制度中的地位和潜在的利益冲突。从2010年12月至2016年5月在Cochrane图书馆进行了随机对照药物试验的系统评价的文献检索。MEDLINE,PsycINFO和Scopus数据库。根据牛津循证医学中心2009版的分类系统分配证据水平。建议的强度是通过多步形式化程序达成共识来实现的。功效,风险,我们权衡了患者对现有疗法的偏好和适用性.这些准则由参与制定准则的协会的董事会审查和批准。
结论:在共病抑郁症或广泛性焦虑症的情况下,推荐阿米替林和度洛西汀,在广泛性焦虑症的情况下,推荐普瑞巴林。如果没有合并症或没有广泛性焦虑症,可以考虑使用度洛西汀和普瑞巴林。不建议使用强阿片类药物。
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 drug trials 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.
CONCLUSIONS: Amitriptyline and duloxetine are recommended in the case of comorbid depressive disorders or generalized anxiety disorder and pregabalin in the case of generalized anxiety disorder. Off-label use of duloxetine and pregabalin can be considered if there are no comorbid mental disorders or no generalized anxiety disorder. Strong opioids are not recommended.