Dokument

Zusammenfassung:
Die Fibromyalgie ist eine chronische Schmerzerkrankung, welche mit muskuloskelettalen Schmerzen in mehreren Körperregionen, vegetativen sowie funktionellen Beschwerden einhergeht. Ursächliche und aufrechterhaltende Faktoren der Erkrankung sind bislang nicht eindeutig identifiziert. Die Ergebnisse früherer Studien deuten auf eine Hyporeaktivität des autonomen Nervensystems, gemessen an den Parametern Puls, Blutdruck, Herzratenvariabilität und Hautleitwert in körperlichen Belastungsphasen, hin. Ein weiterer Ansatz geht von Veränderungen der Muskelspannung aus. Hierbei kamen bisherige Studien zu unterschiedlichen Ergebnissen. Bei einigen fand sich eine geringere Muskelaktivität bei den Fibromyalgie-Patienten im Vergleich zu Gesunden, in anderen Studien konnte kein Unterschied zwischen den beiden Gruppen festgestellt werden. Ein weiterer Ansatz, welcher in neueren Studien untersucht wird, ist die Interaktion des kardiovaskulären Systems, vermittelt über die Baroreflexsensitivität, und körpereigener Schmerzverarbeitung. Bei Fibromyalgie-Patienten fand man im Vergleich zu gesunden Personen eine geringere Baroreflexsensitivität. Neben physischen scheinen auch psychische Faktoren, zum Beispiel beruflicher Stress, eine ätiopathologische Rolle zu spielen. Um die genannten Ansätze zur Entstehung und Aufrechterhaltung des Fibromyalgie-Syndroms weiter zu verfolgen und damit Hinweise auf die Ätiopathogenese der Erkrankung zu erlangen wurden in dieser Studie bei 29 Fibromyalgie-Patienten und einer Kontrollgruppe bestehend aus 34 gesunden Probanden psychophysiologische Parameter in abwechselnd Entspannungs- und Belastungsphasen gemessen. Dabei wurde mentale Belastung durch Kopfrechnen und physische Belastung durch den Druck einer Luftpumpe am Schulterblatt, welcher den Fibromyalgie-typischen Schmerz imitieren soll, erzeugt. Abgeleitet wurden die Parameter Puls, Blutdruck, Herzratenvariabilität, Hautleitwert, Schmerz, Stress und Baroreflexsensitivität. Subjektives Schmerz- und Stressempfinden waren bei den Fibromyalgie-Patienten signifikant erhöht im Vergleich zu der gesunden Gruppe. Die EMG-Messung ergab keine signifikanten Unterschiede zwischen den Gruppen in den einzelnen Untersuchungsphasen. Puls und Hautleitwert waren bei den Patienten signifikant höher, die Herzratenvariabilität signifikant geringer als bei den Gesunden. Die Ergebnisse deuten auf eine Veränderung des autonomen Nervensystems bei den Patienten im Sinne eines erhöhten Sympathiko- und verminderten Parasympathikotonus hin. Zudem war die Baroreflexsensitivität bei den Patienten signifikant geringer als bei den gesunden Probanden. Erklärbar ist dies u.a. durch die mit der Störung des autonomen Nervensystems einhergehenden kardiovaskulären Veränderungen. In der Literatur finden sich Hinweise, dass eine verminderte Baroreflexsensitivität ein höheres Schmerzfinden bedingen und, dass sich aufgrund der operanter Konditionierung der Baroreflexsensitivität ein therapeutischer Ansatz ergeben kann.

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