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Chronische Schmerzsyndrome bei muskuloskelettalen Erkrankungen – wie verschieden sind Fibromyalgie und Long COVID? – Teil 1

Chronic pain syndrome in musculoskeletal diseases—how different are fibromyalgia and long Covid?—Part 1

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Zusammenfassung

Chronische Schmerzen sind in der Rheumatologie ein häufiges Problem. Dabei werden nozizeptive Schmerzen von neuropathischen und noziplastischen Schmerzen unterschieden. Mechanistisch werden Erstere z. B. durch anhaltende Entzündungen erklärt. In der zweiten Kategorie liegen Nervenschäden unterschiedlicher Ursache vor. Noziplastische Schmerzen sind dagegen weder auf eine Gewebeschädigung noch auf eine Läsion im somatosensorischen Nervensystem zurückzuführen. Sie beruhen auf einer veränderten Schmerzwahrnehmung durch Modulation der Reizverarbeitung. Das Konzept der zentralen Sensibilisierung, zusammen mit weiteren neurobiologischen und psychosozialen Mechanismen, erklärt solche Schmerzzustände am besten. In der Rheumatologie spielt die Fibromyalgie (FM) eine große Rolle – zum einen differentialdiagnostisch, zum anderen aber, weil das Management von entzündlich-rheumatischen Erkrankungen durch das gleichzeitige Vorliegen einer FM erschwert werden kann. Im Rahmen der Coronapandemie wurden nach einer stattgehabten COVID-19-Infektion anhaltende Schmerzsyndrome beschrieben, die Ähnlichkeiten mit der FM aufweisen. Es gibt eine zunehmende wissenschaftliche Kontroverse, ob das sogenannte Long-Covid-Syndrom eine eigene Entität oder „nur“ eine Variante der FM darstellt. Diese Diskussion und der aktuelle Kenntnisstand über die Problematik sind Thema dieser Übersichtsarbeit.

Abstract

Chronic pain is a common problem in rheumatology. Nociceptive pain is distinguished from neuropathic and nociplastic pain. Mechanistically, the former is explained by persistent inflammation, for example. Included in the second category is nerve damage of various causes. In contrast, nociplastic pain is not caused by tissue damage or a lesion in the somatosensory nerve system. It is caused by an altered sensation of pain through the modulation of stimulus processing. The concept of central sensitization, together with further neurobiological and psychosocial mechanisms, best explains such pain conditions. Fibromyalgia (FM) plays a big part in rheumatology – on the one hand, as a differential diagnosis, and on the other, because the management of inflammatory rheumatic conditions is made more difficult by the simultaneous occurrence of FM. In the context of the coronavirus pandemic, persistent pain syndromes with similarities to FM have been described after COVID-19 infection. There is an increasing scientific controversy whether the so-called long Covid syndrome is an actual entity or “only” a variant of FM. This discussion and the current state of knowledge on the problem are the subject of this review.

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  1. Rheumatologisches Versorgungszentrum Steglitz, Schloßstr. 110, 12163, Berlin, Deutschland

    Jürgen Braun

  2. Ruhr Universität Bochum, Bochum, Deutschland

    Jürgen Braun

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Braun, J. Chronische Schmerzsyndrome bei muskuloskelettalen Erkrankungen – wie verschieden sind Fibromyalgie und Long COVID? – Teil 1. Z Rheumatol (2025). https://doi.org/10.1007/s00393-024-01603-x

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