It affects about 2 million Italians, especially women. You are not born with fibromyalgia, the disease manifests itself over time: it peaks in incidence between 20 and 50 years. Musculoskeletal pain is the predominant symptom accompanied by numerous other physical and psychological ailments. “It is a chronic syndrome often associated with other pathologies – confirms Piercarlo Sarzi Puttini, director of the Complex Unit of Rheumatology of the Sacco hospital in Milan – including obesity, autoimmune, neoplastic and / or infectious diseases that must be treated separately from fibromyalgia pain. The therapeutic approach therefore includes a wide range of interventions, pharmacological and otherwise “. Correct management of the fibromyalgia syndrome, according to Sarzi Puttini, should include an “integrated multi-specialist approach”, based on four pillars: patient education, physical exercise, pharmacotherapy and psychotherapy. “It is necessary – says the rheumatologist – to help the patient learn to live with the disease. In addition, the achievement and maintenance of a correct physical shape must be pursued “, through weight loss, which helps posture, decreases inflammation and alleviates pain due to overweight, proper nutritional education (not only aimed at the loss of weight) and aerobic exercise. Physical activity helps the patient to “interrupt the vicious circle of pain-inactivity-pain – explains Sarzi Puttini -. The most effective method of raising the pain threshold is physical activity and exercises must be carried out daily, otherwise the symptoms worsen in a few weeks ”. “Some rehabilitation techniques” are also extremely useful, according to the specialist, such as “global postural rehabilitation, stretching, aerobic exercises (walking, movement in the water, swimming, cycling) but also sports such as Nordic walking and fit-walking”. Then there are “hydrokinesitherapy, practiced in thermal water alleviates fibromyalgia pain – says Sarzi Puttini – relaxes contracted muscles, and improves psycho-physical balance, and effective balneotherapy on pain, chronic fatigue, stiffness, anxiety and disorders of sleep. Mud therapy seems to further improve these results ”. Also recommended are the so-called “meditation therapies in movement”, based on physical movement integrated with relaxation and breathing techniques: tai chi, qigong, yoga, pilates, Feldenkrais method. Regarding patient care, the rheumatologist has no doubts: “The development of a therapeutic diagnostic plan (Pdta) for the fibromyalgia syndrome would be particularly important. It would represent a fundamental tool for the management of fibromyalgia patients in order to guarantee an early diagnosis, reducing the costs that affect the NHS due to late diagnosis and improve the services provided, guaranteeing equity of access to treatments throughout the national territory “. To date, the general practitioner, “a central figure because he carries out the pharmacological and clinical surveillance of the patient, in addition to referring him to the specialist”, has been looking after the patient with fibromyalgia syndrome; the rheumatologist / algologist specialist for the “differential diagnosis and second level assessments” and the other operators (the nurse, the physiotherapist / physiatrist, the psychologist / psychiatrist, the rehabilitation expert and the rehabilitation expert). Although there are no definitive cures, to control the disease, “antidepressants, antiepileptics, painkillers, anti-inflammatory and muscle relaxants” are preferred, capable of acting on the mechanisms that trigger pain in the central nervous system. But drugs “alone are not enough”, Sarzi Puttini is convinced, according to whom, among the most promising new non-pharmacological treatments “we include the hyperbaric chamber. Hyperbaric oxygen therapy (HBOT) allows us to increase the partial pressure of oxygen in our blood vessels, and therefore the distribution of oxygen to all tissues. In particular, for fibromyalgia, several studies have reported benefits for high pressure Hbot (2 – 2.5 atm), including a decrease in the pain threshold, an increase of neuroplasticity and induction of neuromuscular efficiency, which in fibromyalgia patients is particularly important and, consequently, an improvement in the quality of life “. Psychological support is also fundamental. “Many lose or give up their jobs or choose a part-time solution because they cannot maintain the required standards. In addition, the difficulties caused by mental fatigue and neuro-cognitive deficits make these people more vulnerable. Even relationships in the family. they are tense and difficult; the patient is always tired, no longer efficient but at the same time he is not understood. This is why the education of family members and caregivers is also important “adds Sarzi Puttini who raises an alarm:” Many of our patients, dissatisfied treatment with traditional drugs, look for alternative solutions relying on barkers who offer expensive and ineffective treatments that often increase the patient’s sense of helplessness and anger. Hence the goal of educating the patient, accustoming him to what we call self management and self efficacy. “On the fibromyalgia syndrome Sarzi Puttini is among the authors of the publications” Fibromyalgia: an update o n clinical characteristics, aetiopathogenesis and treatment NatRevRheumatol ”Nat Rev Rheumatol. 2020 Nov; 16 (11). Fibromyalgia syndrome is a very common disease that is not yet talked about enough. In addition to being frequent, it is also subtle: it is no coincidence that it is called an “invisible disease” because it is difficult to diagnose. Persistent pain and other disabling symptoms are not easily objectified, but the life of those affected is a daily ordeal. To counter this sense of abandonment and “frustration”, Alfasigma supports patients with fibromyalgia syndrome through correct and verified information, with the aim of raising public awareness, spreading greater awareness and improving the quality of life of patients. Alfasigma will deal with, with the help of experts, topics on which a lack of communication has been found, putting the patient in the condition of being able to be an active protagonist in his own treatment path.