Schlafverhalten bei Fibromyalgiepatienten nach Systolischem Extinktionstraining

Fibromyalgia, as a chronic pain syndrome, is characterised by the classical symptom triad of musculoskeletal pain, fatigue and nonrestorative sleep. Many patients also suffer from vegetative and functional, as well as psychical disorders. The prevalence in the German population is approximately 4 %. The diagnosis of Fibromyalgia is achieved by the American College of Rheumatology classification criteria of 2010, respectively 2011. The aetiology of the disease is still not well understood. It is, however, assumed that, in context of a biopsychosocial model, biological, psychological as well as social factors play an important role. A new approach to clarify the aetiology is provided by recent studies which show a decreased baroreflexsensitivity in fibromyalgia patients compared to healthy probands. Baroreceptors seem to play an important role in the intrinsic pain inhibition system. A dysfunctional baroreflexsensitivity in fibromyalgia patients leads to a reduction of the autonomic regulative capacities and consequently to an inability of intrinsic pain inhibition. Recommendations on the implementation of fibromyalgia treatment are so far primarily based on symptomatic therapeutic approaches such as physiotherapy, psychotherapy as well as medical treatment. Each of these treatment methods merely show a temporary relief. Until now, no causal treatment for fibromyalgia patients exists. The above mentioned findings concerning modified baroreflexsensitivity in fibromyalgia show a new treatment approach. Professor Thieme’s research group was able to create a therapy which led to an increase of baroreflexsensitivity in fibromyalgia patients. Through the application of the Systolic Extinction Training, baroreceptors were reactivated by a combination of operant behavioural therapy and baroreceptor training. It was already demonstrated that Systolic Extinction Training has a positive effect on pain perception in addition to the clinical improvement. Assuming that Systolic Extinction Training represents a new, promising treatment approach, it must be shown that this therapy also improves other impairments caused by fibromyalgia. In order to verify ameliorations after Systolic Extinction Training regarding sleep in fibromyalgia patients the Pittsburgher sleep quality index was used to investigate subjective sleep quality in the framework of a controlled, randomised study including 84 probands. For the purpose of analysing objective sleep parameters, polysomnographic recordings were assessed within a pilot study including eleven fibromyalgia patients. By treating affected patients with Systolic Extinction Training an improvement in subjective sleep quality could be shown, mainly demonstrated by a significant reduction of the overall score within the Systolic Extinction Training- group. Additionally, a significant difference between the group treated with Systolic Extinction Training when compared to two other control groups after therapy could be demonstrated. These control goups were either treated with a combination of aerobic trainig and baroreflex training or else a combination of operant behavioral therapy and electric stimulation applied independently from the cardiac cycle. Furthermore, a significant increase of the proportion of good sleepers after Systolic Extinction Training could be demonstrated. The Systolic Extinction Training also affected objective polysomnographic parameters such as an increase in slow wave sleep and a reduction of wake after sleep onset in the first half of the night. After all, an improvement of sleep architecture by approaching a physiological distribution of slow wave sleep could be demonstrated. It thus stands to reason that Systolic Extinction Training not only leads to a decrease of pain, but also improves sleep in fibromyalgia patients. The aim of future research work should be focused on repeating the presented investigations in context of a larger number of probands in order to verify the repeatability of the findings presented in this study.