Fibromyalgia

Guidance for Fibromyalgia Patients Who Are Having Elective Surgery – An Update

If you are having a major surgical procedure, there are some issues that you may wish to discuss with your surgeon and anesthesiologist that could reduce the "fibro-flare" that often occurs after surgery in fibromyalgia patients.

1. Pain after surgery is inevitable because nearly all surgeries result in trauma to the skin and muscles. This post-surgical pain is usually accentuated in fibromyalgia patients due to their enhanced pain processing (see central sensitization).

2. Request that you wear a soft neck collar to reduce neck hyperextension (if an endotracheal tube is anticipated). This will help minimize inadvertent stretching of your neck muscles during positioning while you are unconscious.

3. Request that your arm with the intravenous line be kept near your body, not away from your body or over your head. This will help minimize inadvertent stretching of your arm and shoulder muscles during positioning while you are unconscious

4. Sometimes "postoperative myalgia" is due to the use of a muscle relaxant drug called succinylcholine. If you have experienced this in previous surgery, I suggest you mention this to your anesthesiologist.

5. Request that you be given a pre-operative opioid pain medication – about 90 minutes prior to surgery. Opioids are morphine or morphine related drugs. The rationale for the pre-operative use of opioids is to minimize “central sensitization” - as this inevitably worsens the widespread body pain that you are already experiencing.

6. Ask to have a long-acting local anesthetic infiltrated into your incision - even though you will be asleep during the procedure. The rationale for this is to minimize pain impulses reaching the spinal cord and brain, which in turn drive central sensitization.

7. As a fibromyalgia patient you will need more, and usually longer duration, of post-operative pain medication. In most cases opioids should be regularly administered or self administered with a PCA pump (patient controlled analgesia).

8. Most fibromyalgia patients require a longer duration of post-operative convalescence, including physical therapy in many cases. Gentle stretching and reconditioning of muscles should start soon after the incision is well healed.

[See also the important article, "Recommendations for Persons with ME/CFS or Fibromyalgia Who are Anticipating Surgery," by Dr. Charles Lapp, MD, director of the Hunter Hopkins Center for ME/CFS/FM in Charlotte, NC.]

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* This information is reproduced with kind permission from the non-profit (Fibromyalgia Information Foundation website) – an archive of helpful information for people with FM founded by the noted rheumatologist Robert Bennett, MD, exercise physiologist Sharon Clark, PhD (co-authors of the Fibromyalgia Impact Questionnaire or FIQ), and their colleagues in the Fibromyalgia Research & Treatment Team at Oregon Health & Science University in Portland.

Among the many other helpful articles you'll find at the Fibromyalgia Information Foundation website is a collection of "Exercise Advice" resources for people with FM.

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat, or cure any disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.