Empfohlen wird montags bis freitags von 9 bis 12 Uhr und von 13 bis 18 Uhr anzurufen. Bitte nicht vor 9 Uhr anrufen. Heiraten im Standesamtszimmer an Land. Oekumenische Trauung in der Burgkapelle. Mai Hochzeitsfeste auf einem Rheinschiff. Rhein Hochzeit Schifffahrt mit Feuerwerk, Sa. Danach auf Wunsch Ausstieg in Boppard. Bordparty mit 2 DJs in 2 Salons und 2 Buffets. Feuerwerk-Schiffahrt nach Winningen, Mosel So 2. Rhein Mittelrheintal zwischen Koblenz, Loreley und Mainz: Juni Jeden Sonntag, 10 Uhr: Anfragen Mobil Juli Jeden Sonntag, 10 Uhr: August Jeden Sonntag, 10 Uhr: August , September Jeden Sonntag, 10 Uhr: September , Rheinwiesenfest am Rheinufer bei Bacharach.
September , Rhein in Flammen Oberwesel. September , Rhein in Flammen St. Weinfest in Boppard , Marktplatz. Oktober Jeden Sonntag, 10 Uhr: Weihnachtsurlaub in Deutschland Weihnachten Weihnachtsreisen. Weihnachten mit Hund im Hotel. Der Weihnachtsmann kommt zur Bescherung in diese Hotels. April Jeden Sonntag, 10 Uhr: April , Weinhexennacht in Oberwesel. Mai Jeden Sonntag, 10 Uhr: Mai , Maiausflug am Mittelrhein.
Roland Staud, University of Florida, Gainesville, US, likens the current understanding of fibromyalgia to the traditional Indian story of seven blind mice trying to determine the identity of an elephant. One blind mouse feels a leg and calls it a pillar; another grabs ahold of the tail and reports finding a rope. Not until all the parts are considered as a whole does a complete picture of the beast emerge.
Likewise, rheumatologists with patients complaining of muscle aches may diagnose fibromyalgia, whereas a gastroenterologist proclaims IBS the cause of pain, but apart from complaints of regional pain in IBS, the overall symptoms of these two conditions look remarkably similar. Patients with low back pain, osteoarthritis, and other common chronic pain conditions can also develop this characteristic set of symptoms. Today, researchers are sketching out a picture of fibromyalgia as a pain disorder that can be triggered by any number of individual maladies, each one heightening future risk for developing this enigmatic condition.
Researchers and doctors have traditionally classified different types of pain into several categories. Nociceptive pain is the acute protective signal of impending tissue damage that arises from stepping on a tack, for example. Inflammatory pain results from the activity of immune cells, as in osteoarthritis. And neuropathic pain springs from nerve damage that results from diabetes or chemotherapy, for instance.
Over the years, researchers have tried to craft a new category to contain fibromyalgia, which they have variously called functional, dysfunctional, or somatoform disorders. Without evidence for bodily injury underlying the pain, many researchers turned to studying the brains of people with fibromyalgia. Some, including Clauw, have embraced the idea that fibromyalgia is primarily a disease of the brain. The unifying symptoms, like widespread pain and fatigue, of fibromyalgia and other such syndromes indicate that changes in the central nervous system are at play, Clauw says.
Brain imaging studies have indeed shown evidence of structural and functional changes in the brains of patients with fibromyalgia. And anti-depressant and anti-seizure medications that are effective for some people with fibromyalgia work in the brain, he adds. But other researchers contend that all chronic pain conditions lead to changes in the brain, and in fact every experience of pain—whatever its initial cause—emerges from the brain.
Many researchers in the field therefore are still searching for as-yet-undetected pathological processes in the body that may be driving the symptoms of fibromyalgia—processes that might be reversible. Evidence of peripheral nerve damage In , several groups published evidence of neuropathy, or damage and dysfunction, in the small nerve fibers that transmit pain signals from the skin, in patients diagnosed with fibromyalgia. One study led by Claudia Sommer, University of Würzburg, Germany, found dysfunctional nerve activity in twenty-five adults with fibromyalgia, according to sensory testing in which subjects reported when they detected hot or cold stimuli and electrical recordings of peripheral nerve activity.
In addition, skin biopsies from fibromyalgia patients often revealed withered or sparse nerve endings. These abnormalities were not present in healthy control subjects or in ten subjects without pain but with depression, a condition that shares some aspects of fibromyalgia such as fatigue and inactivity. Oaklander found that forty-one percent among 27 adult subjects meeting diagnostic criteria for fibromyalgia also met the diagnostic criteria for small-fiber polyneuropathy SFPN , a common neuropathic pain condition with myriad causes, whereas only three percent of healthy control subjects showed signs of SFPN.
A third study , led by Jordi Serra, MC Mutual, Barcelona, Spain, and Neuroscience Technologies, London, UK, measured dysfunctional nerve activity in the peripheral nerves of fibromyalgia patients and showed that it mimicked nerve activity seen in patients with SFPN but not healthy controls.
Together, these reports suggest that, somehow, damage to or dysfunction of peripheral nerves is a contributing factor in many cases of what has been diagnosed as fibromyalgia. But many questions remain about the link between neuropathy and fibromyalgia. Most cases of SFPN can be traced to potentially treatable conditions including diabetes, chemotherapy for cancer, an autoimmune reaction, or—rarely—a genetic abnormality; some cases of SFPN remain mysterious in origin.