[Diagnosis and therapy of fibromyalgia syndrome]

The meaningfulness of the term fibromyalgia syndrome (FMS), possible diagnostic criteria, and the therapeutic procedure, were for a long time points of contention between different professional associations. In an interdisciplinary S3 guideline on the definition, pathophysiology, diagnosis and therapy of FMS, it has now been possible to work out a consensus that is accepted by all involved professional associations and patient representatives on the basis of the available evidence. The most important results for clinical practice are presented and discussed here using case examples. The number of FMS patients in Germany is estimated to lie at 1.6 million (2% of the population), and 80-90% of those affected are women. FMS is classified under the functional somatic syndromes of the diseases of the musculoskeletal system and of the connective tissue (ICD 10 M 79.7). Comorbidities with other functional somatic syndromes and mental disorders are frequent. The clinical diagnosis of an FMS can ensue both by examining the tender points and also based on symptoms. Basic therapy includes elucidation and psychoeducation, aerobic endurance training adapted to the individual performance capability, operant behavioural therapy, and as a drug-based therapy option, amitriptyline 25-50mg/d (all level of evidence 1a). A graded therapeutic procedure which includes the patients in the decision-making is recommended.