The musculoskeletal pain that has been widespread for at least three months it is the symptom that most distinguishes it, associated with numerous other disorders that can persist throughout life. And the fibromyalgia, a chronic syndrome far more frequent in women than in men, with a 5 to 1 ratio and a peak incidence between 20 and 50 years, although it can occur at any age. “It affects about 2 million Italians, but there is still too little talk about them “, says Piercarlo Sarzi Puttini, director of the Complex Unit of Rheumatology at the Sacco hospital in Milan.
“Fibromyalgia – he continues – is characterized by widespread musculoskeletal pain, sleep disturbances, chronic fatigue, neurocognitive alterations and many other more or less recurrent symptoms, such as irritable bowel syndrome and headache, which can last forever, with an impact significant on the quality of life of those affected. “The causes of the disease, which many heard about for the first time when the American pop star Lady Gaga claimed to suffer from it, are not known. The genetic predisposition, however, seems play a fundamental role “both for the familiarity observed – underlines Sarzi Puttini – and for the presence of various genetic polymorphisms present in the regulation of the nociceptive system. In addition to this genetic substrate, a variety of peripheral and central mechanisms are shown to play a role in the onset of fibromyalgia symptoms. ”
“There is in fact – he explains – one evident interaction between genetic factors, environmental factors (physical trauma after car accidents, trauma of a sexual nature, diseases) and individual predisposition linked to the ability to adapt to chronic stress situations and psychological aspects (anxiety, depression, obsessive-compulsive disorders and post-traumatic stress disorder). All this causes changes in the somato-sensory nervous system, which lead to an altered threshold of pain perception, and is clinically expressed with allodi, or the perception of a painful sensation following a harmless stimulus, and hyperalgesia, which consists in perceiving a painful stimulus as excessively painful “.
As if that weren’t enough, diagnosis is an obstacle course. In fact, the patient consults many specialists before arriving at the correct evaluation. “The diagnostic criteria – remembers Sarzi Puttini – were originally defined by the American College of Rheumatology in 1990 and included a history of chronic pain spread for at least three months and the presence of at least 11 out of 18 tender points. The recognition of fibromyalgia is complex and requires an expert figure for its diagnosis, in fact, there is no biomarker and the 2010/2011 diagnostic criteria include a series of symptoms common to other diseases. These criteria to date – explains the expert – are based on an evaluation that understands 2 scores that add up: painful areas (0-19) and symptom severity scale (0-12)“.
The patient learns to live with the disease, the symptoms of which tend to subside over time. “The cohorts that studied long-term patients – remembers Sarzi Puttini – show that about 15-20% can achieve prolonged clinical remission even if fibromyalgia, in the face of traumatic events or prolonged stress situations, can resume with same intensity as onset. In some cases an alternation of functional symptoms with different clinical intensity is observed (headache, irritable bowel, recurrent cystitis, chronic asthenia, psycho-affective disorders). Therefore, we still do not have fully satisfactory therapeutic approaches “for the treatment of this syndrome, often associated with comorbidities. “Disorders of the affective sphere, gastrointestinal affections, obesity, which must be evaluated and treated in an integrated manner for the importance they play on fibromyalgia symptoms.” In other cases, it is associated with autoimmune diseases (rheumatoid arthritis, Sjogren’s syndrome), neoplastic and / or infectious that “it is often necessary to treat in a separate way from fibromyalgia pain”.
“The therapeutic approach therefore includes awide range of interventions, pharmacological and otherwise, and for this reason it must be studied for the single patient “. Although there are no totally effective drugs, nevertheless drug therapy “is important – Sarzi Puttini specifies – for the control of symptoms, for pain and to help sleep. Antidepressants (e.g. amitriptyline), antiepileptics (e.g. pregabalin), painkillers (e.g. tramadol), analgesics / neurotrophics (e.g. L-acetylcarnitine), anti-inflammatory and muscle relaxants are preferred, able to act on the mechanisms that trigger pain in the system central nervous. Among the novelties the use of therapeutic cannabis, particularly interesting even if a controversial drug, but the preliminary results of some studies are rather encouraging, especially with respect to the management of pain and sleep disorders “. Medicines, however, “alone are not enough. The approaches that are able to complement, without replacing, conventional pharmacological therapies, including acupuncture, spa-therapy, ozone therapy, and mind-body techniques (yoga, pilates, Feldenkrais method), are fundamental “, he concludes.