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Fibromyalgia: a new protocol built around you.

Fibromyalgia is a common condition that hits about 2% of the population in average. It is a chronic condition that can result in a real challenge for the doctor and it can be frustrating for the patient: it involves such a wild variety of symptoms other than pain that the patient’s whole life is affected. Only recently, Fybromialgia was recognized as a clinical condition, instead of psychological, that involves symptoms such as stiffness, sleep and mood disorders, cognitive issues (often caused by the drugs a patient needs to take as a treatment) and muscolar pain..

The Department of Medicine, Section of Rheumatology in the University of Verona, is a true excellence in the field, not only in Italy but in the world as well: it is responisble for many breakthrough therapies in rheumatic conditions like, for example, Neridronate infusions for CRPS. Through a partnership with the Department of Philosophy and Anthropology of the University of Bologna, it was possible to create a more complete treatment for these patients as well.

The traditional approach to this condition is the same as the one for any condition: the Biomedical Model, which, unfortunately, is not enough to give a complete answer to all of the patient’s needs. After the condition is diagnosed, the patient usually is visited by various different specialists that can only prescribe drugs that will, hopefully, take care of every single symptom. Needless to say that often these treatments don’t work, increasing the patient’s frustration. Typically, someone affected by Fybromialgia develops quite a knowledge on the subject: the number of specialists, the huge amount of blogs and pages on Internet, allows a person to have a complete idea of this condition and available treatments. Unfortunately, usually this idea is wrong. The number of highly subjective symptoms that this condition involves translates in the need for extremely subjective treatments: what will work for somebody might not be as effective for someone else.

The partnership between the University of Verona and Bologna was able to create, back in 2006, a protocol that, after interviewing the treated patients 2013, has seen real results. The basic philosophy behind this new approach is to consider not only the disease, meaning the physical symptoms which, of course, will need medical treatment, but also the illness, meaning all of the psychological side of Fybromialgia. This is useful to create a fully customized treatment for each and every patient aiming a drastical reduction of the chronic pain and the flares but, mostly, trains the patient’s self-managing skills in order to improve the whole living. To consider the patient as a person means to take care of every issue in the most complete way, what we call bio-psycho-social model. This means that the treatment adjusts to the patient and not reverse. In this picture, a multi-disciplinary approach is mandatory because a real and effective treatment starts from the collaboration between different specialists coming from a wide rage of different backgrounds all concentrated on the same goal: to modify the health status of the person battling Fybromialgia.

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Diego Gonzales

On your mark get set and go now. Got a dream and we just know now we're gonna make our dream come true. Doin' it our way. Nothin's gonna turn us back now. Straight ahead and on the track now. We're gonna make our dreams come true.

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Why is Neridronate treatment in Italy useful in any case?

Complex Regional Pain Syndrome is one of the most challenging conditions to diagnose and treat. It is a chronic neuropathic pain syndrome involving sensory, motor and autonomic changes. Each CRPS patient is unique and feels differently from another one: different levels of pain, different swelling or skin coloration, different causes and different reactions to medications.

This great variety of phenomena involving the condition is one of the causes of the difficulties a pain doctor might encounter while considering how to treat his patient. Right now, the most used treatments are nerve blocks, opioids, N-methyl-D-aspartate inhibitors (such as Ketamine) or corticosteroids.

Along with these drugs, doctors usually recommend an interdisciplinary approach as a treatment; this would make it easier to indicate which treatment is the best for the patient. The main problem is that all of these indicated treatments might give pain relief, but it always is in the short term (the longest-term one, of the above, statistically, is the nerve blocks with up to one year of relief).

This is why a CRPS affected person will have to spend an average of 20000 $ per year in treatments: expenses to treat a condition, especially when it is chronic, inevitably rise. One of the treatments that is reportedly considered one of the most interesting and study-worthy, is the use of Bisphosphonates. Bisphosphonates are molecules used especially for Rheumatic and bone pain and, so far, it looks like it is the treatment ensuring the longest-term benefits. Among these Bisphosphonates, Neridronate is the only one that can be administered both intravenously or intramuscularly; usually oral Bisphosphonates are the treatment of choice for most of the bone diseases. Orally taken bisphosphonates, thought, can come with some side effects like jaw necrosis, local ulceration and irritation of the stomach and esophagus. Although this is still useful for conditions like Osteogenesis Imperfecta or Piaget Disease of Bones, Italy regularly treats CRPS with Neridronate infusions since 2013, after the testing phase in Verona.

It is unknown on how Neridronate works on the condition because, as written above, its whole pathophysiology of CRPS is very unclear and still under debate; for example, the simple difference between CRPS type 1 and type 2 is not as marked as one would think and, therefore, most doctors treat the two conditions in very similar ways.

CRPS is a condition that, most of the times, naturally disappears within two years from onset and, once it has disappeared, it is rare for it to naturally come back (it would need another accident or trauma for it to happen, statistically speaking). Of course, since it is such a debilitating and painful condition, a person cannot wait this much time to find out if he or she is lucky enough to see CRPS just “fade away” on its own. Neridronate is found to be the most effective to obtain indications on RSD: in Italy, this treatment directly corresponds to this condition. This means that, as soon as one is diagnosed with Complex Regional Pain Syndrome, he or she will also get these infusions and, within a couple of month, expect a complete remission. This will happen only for early-diagnosed patients but, even in people that dealt with Algodystrophy for years, it causes a great relief. Of course the level of that relief variates from patient to patient: for example a person might feel a 20% to total pain relief, very few none at all, every patient is different but, at various levels, Neridronate will work.

As previously advised, an interdisciplinary approach to the condition, is the best option: for example physiotherapy will certainly help with the stiffness and blood circulation, painkillers will help in pain management for the two or three months the drug needs to kick in at full effect.

Bloomberg classified Italy the “Healthiest Country in the World” in 2017. This is possible only thanks to a top quality Health System with healthy diet and healthy habits in general. If the patient can manage the flight stress, Italy is the place to go for a CRPS patient: the prospective is of getting the best treatment available right now, from the doctors of the same team that brevetted Neridronate in Verona University Hospital Company (AOUI) and (why not?) enjoy one of the most beautiful countries in the world.

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Evans Corner

On your mark get set and go now. Got a dream and we just know now we're gonna make our dream come true. Doin' it our way. Nothin's gonna turn us back now. Straight ahead and on the track now. We're gonna make our dreams come true.