2023-07-13 14:57:52
by Chiara Daina
This pathology is often not yet recognized and those who suffer from it do not currently have the right to exemption from co-payments for necessary health services. A problem which it is hoped will be resolved within the year
A widespread pain in several points of the body, legs, buttocks, back, arms, neck and jaws, which can arise with the slightest effort, such as climbing stairs, or after having contracted the muscle for a long time to maintain a position. It can be associated with chronic fatigue, headache, sleep and gastrointestinal disorders, difficulty concentrating, confusion, memory impairment, as well as anxiety and depression. These are the symptoms of those who suffer from fibromyalgia and who are often not believed, even by doctors.
A difficult disease to diagnose
Due to the difficulty in diagnosing and the lack of information on the syndrome there are many underdiagnosed and untreated cases, particularly among young women considered only “stressed out and a little hysterical”, but also several cases of “false positives”, in those In reality, he has muscular or postural pains of other origins, comments Lorenzo Dagna, professor of Internal Medicine and head of the Immunology, Rheumatology, Allergology and Rare Diseases Unit at the San Raffaele University Hospital in Milan.
Women are more affected
Fibromyalgia affects approximately 2 million Italians, mostly women, with a peak between the ages of 20 and 50. But they have always been invisible patients, because fibromyalgia for now is not included in the list of chronic and disabling diseases of the Ministry of Health, which entitles you to exemption from the copay for necessary health services. Nor can it be included as a diagnosis in sickness certificates and hospital discharge forms.
However, the National Commission for updating the essential levels of assistance (Lea) has long since given a favorable opinion on the inclusion of the severe stage of the syndrome in the list and the entry into force of the Dpcm with the new ones is expected by the end of the year Lea, including those for fibromyalgia.
Symptoms
In the event of widespread pain, especially musculoskeletal pain, which has persisted for at least three months, accompanied by asthenia, unrefreshing sleep and other symptoms of the disease (described above, ed.) it is advisable to contact your general practitioner who, in case of uncertainty or when the symptoms are not solvable with a lifestyle correction, he will be able to refer to the rheumatologist, considered the specialist of reference, for further information explains Dagna.
Diagnosis can be an obstacle course if the doctor is not trained. There is no clinical exam to ascertain fibromyalgia. it is essential to quantify the impact on the quality of life reported by the patient through pain, fatigue, and assessment scales, who in the most extreme cases isolate themselves at home without doing anything else – underlines the expert -. important, then, to exclude that it is other pathologies, for example rheumatological and neurological. Fibromyalgia, moreover, can be concomitant with other diseases, especially of an autoimmune type, such as rheumatoid arthritis and lupus.
The treatments
The treatment plan is personalized. First of all, it is prescribed to practice aerobic physical activity and relaxation techniques, such as Tai Chi. Motor exercise by increasing the stimulation of the pain receptors activates the neuromodulator mechanisms which reduce the subject’s hypersensitivity. Weight control with a healthy and regular diet is essential, since the extra pounds load the joints, aggravating the sense of pain. Cognitive-behavioral therapy is recommended as a support. The most serious situations are managed with neuromodulatory drugs, antidepressants with myorelaxant effects and cannabinoids. While analgesics and anti-inflammatories are indicated only for mild pain and for short periods – clarifies Dagna -. Fibromyalgia is a chronic disease, but you can learn to live with the symptoms by keeping them under control.
Regions in random order
With the decree of 8/7/2022, for the first time, a contribution of 5 million euros was allocated among the Regions to be allocated to the study, diagnosis and treatment of fibromyalgia. The fund had been allocated by the budget law for last year but the disbursement was linked to the identification by each Region of specialized centers of reference for taking charge of patients affected by the disease. So far only 11 Regions have communicated the centers to the Ministry of Health: Valle d’Aosta, Veneto, Liguria, Molise, Piedmont, Lazio, Friuli Venezia Giulia, Tuscany, Marche, Umbria and Lombardy.
Valle d’Aosta has also introduced an exemption code from the ticket for visits and diagnostic tests and a specific one for two muscle relaxant drugs. The autonomous provinces of Trento and Bolzano, in addition to having established the reference clinics, also have an exemption code for health services (but not that for medicines). In addition, the Sardinia Region has established an experimental bonus of 800 euros per year per patient (with certified diagnosis) until 31 December 2024. The application must be submitted to the Municipality of residence.
The requests of the Fibromyalgia Committee
In Parliament, between the Chamber and the Senate, at least 12 bills have been presented during the current legislature for the recognition of fibromyalgia. One of these, number 984 deposited in Montecitorio, was signed by the main political forces and was promoted by the
United Italy Fibromyalgia Committee
. Eleven articles, which ask: to include fibromyalgia in the list of chronic and disabling diseases (which allows for exemption from co-payment expenditure), defining the different degrees of disability, and in the essential levels of assistance; to set up diagnostic, treatment, rehabilitation and prevention pathways; to promote studies on the disease and its social and occupational impact; to recognize the role of associations to support the sick; to encourage telework; to create regional networks of fibromyalgia clinics, a national epidemiological register and information and awareness campaigns on the syndrome for citizens.
July 13, 2023 (change July 13, 2023 | 2:57 pm)
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