The third National Congress of the Italian Society for the unified and interdisciplinary management of musculoskeletal pain and algodystrophy kicks off today in Rome (Si-Guida) which starts from the assumption of proposing musculoskeletal pain not as a symptom of a disease, but itself a pathology to be diagnosed and treated appropriately, according to therapeutic diagnostic paths defined with multidisciplinary teams composed mainly of orthopedic, rheumatologist and physiatrist.
“In line with the mission of the Society, in our third national congress, we will compare the different medical professionals – has explained Giovanni Iolascon, orthopedist and physiatrist and Executive Director of Si-Guida – with the aim of addressing the clinical, surgical and rehabilitative aspects of the patient with non-oncological musculoskeletal pain. Pain management, in fact, represents an important health problem and the impact of Covid-19 has further complicated the approach to this clinical condition from both a diagnostic and a therapeutic point of view “.
The most frequent localizations of chronic musculoskeletal pain are the back region, the lumbar region, the head and the posterior region of the neck and the peripheral joints, mainly the knee.. Chronic pain is more common in the elderly, low-income population and women. The causes that can determine it are many, among the most common: osteoarthritis and arthritis (in 42% of cases), diseases of the tendons, ligaments and bags, especially at the shoulder level, disorders of the intervertebral disc, fractures, headaches, pain syndromes of the muscle groups. According to data from the observatory on chronic pain in Italy it is a problem that affects 26% of the Italian population, while the percentage rises to 74% if we consider the population between 60 and 80 years.
“Often, provocatively, we ask ourselves whether it is important to study musculoskeletal pain,” he says Umberto Tarantino, of the Tor Vergata Polyclinic Foundation and president of the Scientific Society. “The answer is obviously that both research and study of this condition are fundamental for many reasons. In fact, musculoskeletal pain is notably widespread in the population, especially in the elderly, and involves enormous costs both for direct and indirect management. of the problem with a significant impact on the patient’s life, both from a functional and psycho-emotional point of view “.
The congress will focus its attention on some pathologies known to be responsible for musculoskeletal pain such as:algodystrophy, a multisystemic, multisymptomatic, underdiagnosed and undertreated disease; L’arthrosis, a major cause of disability and low back pain. All pathologies that have a minimum common denominator: chronic pain, defined as pain that persists continuously or occasionally for over 3 months. The chronicity of pain depends on complex phenomena, in particular central sensitization, ie the increase in the reactivity of nociceptive neurons in the central nervous system to a normal afferent input, represents the pivotal pathophysiological element. This phenomenon, clinically, cannot be directly measured, but can be deduced from the manifestation of hyperalgesia (pain felt in an exaggerated way following a stimulus that is even slightly painful) and allodynia (sensation of pain even for non-painful stimuli).
L’Algodystrophy (or Complex Regional Pain Syndrome, CRPS type 1) in its typical form, meeting the Budapest criteria, it has a probably underestimated incidence of 26 cases per 100,000 subjects per year, and presents clinical manifestations consisting of an intense inflammatory process, usually limited to the extremities of the upper limbs (wrist, hand) or lower (ankle, foot) which is accompanied by severe district osteoporosis. There are, however, a large number of cases that do not fall within the aforementioned diagnostic criteria even though they show some signs and symptoms of the disease. In this way, the frequency of algodystrophy is certainly much higher and affects, for example, 1 in 4 fractured wrists. In fact, in most cases the disease develops after a trauma, with a pain that is disproportionate to that expected based on the trauma itself. In the full-blown phase, the pain takes on the characteristics of hyperalgesia and allodynia.
If not treated early algodystrophy can cause permanent disability in hand and foot function, with all that this can entail for the patient’s quality of life. “Algodystrophy – concludes Iolascon – is a perfect example of chronic painful pathology of which there is an urgent need for better knowledge in order to be able to identify it early and treat it just as early and appropriately with drug therapy with bisphosphonates, in particular neridronate, the only drug approved for the treatment of this disease. Early diagnosis and appropriate intervention are the two pillars for a correct management of this debilitating pathology“.
The congress will also dedicate a session to low back pain in consideration of the proclamation of 2021 as “Global year about Back Pain” by the Iasp (International Association for the Study of Pain). Low back pain is correctly defined as “pain in the posterior region of the trunk between the lower edge of the twelfth rib and the lower gluteal folds, which may or may not be accompanied by pain in one or both of the lower limbs.” This is not only a widespread health problem worldwide, with a prevalence estimated at around 7.5% of the population, but it represents the main cause of disability in industrialized countries.
Among the topics of discussion of the three days, that of arthrosis will also be addressed. The latter is one of the most common musculoskeletal diseases, considering that 80% of individuals over the age of 55 have signs of the disease documented by X-rays. Every year, almost 52 million individuals are added to the total number of people affected. The disease, due as primum movens to a destruction of the cartilage, progressively involves the entire joint which becomes painful, edematous and difficult to mobilize.