All the symptoms that can indicate a “fibromyalgia”: but the remedies are not conclusive

In Italy it is not included in the list of chronic diseases that fall under the LEA. Yet it is a disorder that affects very heavily everyday life

Since 1992, WHO, the World Health Organization has recognized fibromyalgia as a pathology and classified it in the International Statistical Classification of Diseases and Related Health Problems.


In our country, unfortunately, basic research, clinical trials and treatment prospects for this pathology are far behind, so much so that to date, it is not even included in the list of chronic diseases that fall under the LEA (Essential Levels of Assistance) .


At the beginning of the year, however, a public body, the Emilia Romagna Region, issued guidelines for the diagnosis and treatment of fibromyalgia. The document aims to define in the most appropriate way possible both the pathology and the intervention paths once diagnosis is made.

«The term fibromyalgia is not rarely abused and used to identify painful conditions much less important, easily resulting in superficiality and diagnostic inaccuracy. A very large number of patients are in fact suffering from painful myofascial syndromes that cannot be classified as true fibromyalgia both for the presence of a lower pain intensity and for the absence of the clinical psycho-aptitude corollary typical of the real pathology.

For the purpose of a desirable recognition of fibromyalgia in LEAs, this distinction is appropriate and should not be missed by the specialist physician »clarifies Angelo De Cata Head of UOAS IRCCS House for the Relief of Suffering of San Giovanni Rotondo (FG) and national president of the College of Rheumatologists (CReI).


According to some epidemiological estimates, it can take up to two years before arriving at the diagnosis of disease: the difficulty of the route is linked to numerous variables, in particular to the lack of homogeneous diagnostic routes in all Italian regions.

“To make a diagnosis, three criteria must be met at the same time, namely the presence of diffuse and symmetrical pain that is enhanced in some anatomical points known as tender points which in theory should not be less than 11 even if more often than 18, located in specific areas and regions of the body. The persistence of the pain syndrome for no less than 3 months . The presence of other signs and symptoms such as a corollary constant fatigue since morning awakening , non-restorative sleep, cognitive problems, migraine, respiratory embassy, ​​irritable bowel syndrome, anxious-depressive syndrome, which greatly amplify the compromise in the quality of daily life- De Cata further adds – The diagnostic criteria of fibromyalgia syndrome have improved over the years both in terms of of sensitivity rather than specificity, but not so much as to allow a diagnosis of certainty which, however, cannot be separated from a careful exclusion of other similar clinical conditions ».


Once the diagnosis is made, we move on to the therapeutic path which unfortunately is not a solution to the condition, but aims to keep the symptoms under control and improve the quality of life of those who suffer from it.

“As regards pharmacological interventions for pain management, especially if mild, the use of paracetamol alone is recommended and if the pain is disabling, it can be associated with tramadol, an opioid, while cortisone drugs are of no use. or NSAIDs (non-steroidal anti-inflammatory drugs) – explains Dr. De Cata who continues – Other molecules with central pain-relieving action available and alternatives to tramadol are tapentadol, the oxycodone associated with paracetamol or naloxone, the codeine associated with paracetamol. Some classes of drugs known to be anti-depressants that can be administered in intensely painful forms, even in the absence of a clinically relevant form of depressive state, are of particular use especially for the management of pain and mood disorders.

You can also try to resolve the pain with the pregabalin antiepileptic and with centrally acting decontracting drugs such as cyclobenzaprine, tizanidine, baclofen, eperisone hydrochloride, with which you can save on the dosage of pain relieving drugs and achieve more effects. complete and deep on pain. Clinically important is also to try to improve the quality of night’s sleep which may require pharmacological support of various chemical profiles up to the use of anxiolytics and hypno-inducers ».

NEVER neglect the physical activity

Physical activity can also be very useful for the patient with fibromyalgia because it can improve their mood and allows the muscular system to exercise creating both muscle relaxation and greater tolerability to pain. The physical work plan, however, should be tailored to each patient.


In order for the therapeutic path to be effective in the management of this complex disease, it is essential to intervene both on the physical and psychic spheres. “To get to setting the path by focusing on the physical and the psyche it is essential that the rheumatologist, the reference specialist for the management of this disease, is able to empathize deeply with the patient, because the rheumatologist cannot be just a mere figure that dictates the times and the levels of therapy,

The psychic discomfort that constantly accompanies the most severe forms of this pathology and physical work, when intense and chronic, are the two main variables that create clinical exacerbations of pain, sometimes undermining the patient’s feeling that he cannot have a solution with any therapy or to not have the right person in that specialist to manage your problem. This is the main reason that often invites the fibromyalgia patient to change the medical interlocutor by often entering a loop that does not allow a real growth in the therapeutic aspect “.

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