09 Ott Fibromyalgia The disease of the rich
“The disease of the rich”
There are chronic diseases, for which the monthly disbursements are several hundreds of euro. The therapy does not save lives, also because you are almost never at risk, but the improve of the net, given that those affected often becomes an invalid.
This is the case of diseases that are chronic such as Fibromyalgia, which rose to prominence especially in the last two decades.
Diagnosed according to the criteria of the American College of Rheumatology with the palpation of the 18 trigger points, causes severe pain and stiffness in the muscles, resulting in a sharp decline in the quality of life.
In spite of various hypotheses on the etiopathogenesis, diagnosis has been recognized on an international basis in 1994, after the “Copenhagen Declaration”.
In this syndrome can be affected by various parts of the body, and safe becomes a “companion” of life that does not ever feel alone, because it is always around the corner.
The treatments you attempt are many, but the conventional and most commonly used are based on muscle relaxants, and psychotropic drugs.
Care centers specialist are few and almost always related to the classical treatment of the pain; even if forms of alternative care, they have given great results (albeit not decisive).
Osteopathy, supplements, spas, acupuncture techniques and pain coping are the most important ones and their utility is unquestionable.
The reverse of the medal? Are not covered by the SSN, with a few notable exceptions. Exclusive, dr. Alvise Martini, the centre of Pain Therapy at the general hospital of Verona (where they work with other doctors such as dr. Vittorio Schweiger), is clearer on some aspects of this syndrome.
The Operating Unit of Pain Therapy, we address all of the painful pathologies, related to pathologies both acute and chronic malignant or benign.
I am an Anesthesiologist Resuscitator, as the colleagues who work with me. I also have a diploma of reflexotherapy and complementary techniques, and I’m finishing the training in auricolo-acupuncture.
How would you describe Fibromyalgia?
Fibromyalgia is a syndrome, i.e. a collection of signs, in which the pain is often prevails, and is accompanied by other symptoms, such as disturbances: sleep, mood, gastro-intestinal, urological and many others. The symptoms are many, and yet it is amazing how in spite of their diversity, apparently without a pathogenesis common, being reported consistently by almost all of the patients.
It is considered a rare disease?
I would say, is little recognized, the more that rare. An estimate, which is derived from an epidemiology report into a province of the Veneto region, reported a prevalence of 4% in the general population. And, in my opinion, is underestimated.
How many cases of Fibromyalgia in care at the Policlinico of Verona? When you started to treat this pathology?
As the centre of pain Therapy, we are investigating the Fibromyalgia for about 3 years. We visited around 400 patients, most of which are followed by the centre with visits organized.
What could be the causes?
It is difficult to give an answer. Talking with patients you will notice some common characteristics, such as the presence of stressful events or real physical trauma or emotional that precede the onset of the first symptoms, but this is only an observation and not an explanation.
What is the incidence between men and women? There have been cases of cure, or of improvement?
When I revised the diagnostic criteria was mitigated by the preponderance of the diagnosis in the female sex, at present, the estimates have a diagnostic report of 2:1 between men and women. However it remains a disease with a prevalence of women. With regard to the prognosis, most patients remains essentially unchanged, with small enhancements, or small aggravations, with a symptomatology that varies in a sometimes capricious.
You can then consider a chronic disease, in which only very few patients go on to healing.
What are the rehabilitation protocols?
Were compared in the literature the different rehabilitation protocols, but none has proven superior to another. What is probably important is not to abandon the physical activity, even if done in a bland and tired.
What types of care are there? And what is the degree of success?
Currently available therapies are pharmacological, behavioral, and rehabilitation, with the attitude of a multi-disciplinary approach. Drug therapy is not effective alone, because the mechanisms of the disease are still largely unknown.
What are the costs to which the sick person goes to a meeting? And, as it restricts people’s life, especially if associated with other diseases?
Often, in order to defuse some situations, particularly painful, I say that Fibromyalgia is a “disease of the rich”, because, in the best of conditions, the patient, to be able to live a better life, should have the possibility of being able to devote only to his condition, aside from work or family obligations. Of course, this is not possible, and in many cases, the sick are forced to leave the job.
What is the profile of both psychological and socio-economic level of the sick? Often we talk about the depression associated with it, but what is the cause-effect relationship?
It is not easy to outline a profile-type of the patient fibromialgico, the disease does not seem to hit, as it was believed, the population in school to the most high. The depression, but this is a personal opinion, it seems to be an effect and not, or not always, the cause of the disease. The reduction of fibromyalgia to psychological disorder, it seems to me decidedly simplistic.
What are the precautions to take, also of type food? And what are the advice behavior more important?
There is some evidence that part of the syndrome is also an intolerance to foods containing gluten and therefore it seems that a gluten-free diet may reduce some symptoms.
The advice behavior that are most useful are balneotherapy, which is understood as the daily habit and have hot baths, have a function to soothe the pain of muscular contractures, which are especially present in these patients and the maintenance of a moderate physical activity, which does not exceed the threshold of tolerability of the patient. I would like to say also that the daily commitment of the patient is forced to employ to carry out these two activities is therapeutic.
It is a chronic situation with which the patient has to live?
I’d like to say that there is a cure, but current knowledge does not allow us to say.
There is sensationalism around the illness and its cure?
There is little awareness of the disease and there are too many people who take advantage of the desperation of the sick.
Moral of the story: groping still in the dark. All of this unless the patient type is not really well-off and decides to “invest the capital” on their own health. At this point, the question that arises is: we are sick of series A and series B? At present, despite the fact that there is still a definitive cure, the answer appears to be, at least, rhetoric.