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Guidance for Fibromyalgia Patients Who Are Having Elective Surgery

  [ 39 votes ]   [ 5 Comments ]
By The Oregon Fibromyalgia Research and Treatment Team* • • November 18, 2008

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.]

* 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.

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.

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Article Comments Post a Comment

Infomation to Doctors @ patience surgery
Posted by: kcusa
Nov 22, 2008
This article sounds good in theory, but it just doesn't want to be heard by the doctors. I in fact had presented this information to the anesthesiologist AND surgeon which was blatently refused. Not only was I told that they know their jobs, but after the surgury, I could tell from the results of NOT haveing the guidance needed which left me in considerable MORE PAIN/discomfort, the recovery was hurendous. (The operation was for a hernia). I am a 56 year old woman.
Reply Reply

I am recovering from a partial emergency surgery
Posted by: mamacat
Jan 31, 2009
This information is now of course too late to be of benefit to me and I went to the ER and was admitted in "Guarded" condition and not having even had any surgery for about 20+ years I felt totally inept and like a stranger in a foreign land! The whole process was horrendous and I am now feeling worse than when I first got home except for the incision pain being improved. So I am guessing after what I read here that I am now going into a Huge Fibro Flare as I feel horrible all the way around. My Anesthesiologist was wonderful since when I arrived down to the O.R. Area I was in full blown "Withdrawal" from alll of my regular Pain Mgmt medications as the Dr's were not "My" Dr's and I liver in an area that is very Non Fibro/Chronic Pain Friendly already! I had my Gall Bladder removed and was very ill from stones blocking all my bile ducts also went through Nuclear Ultrasound as well as a Horrendously done ECRP prior to the actual surgery. I know this is getting rather lengthy but if it helps someone I'd be happy for the total stay at this hospital was so terribly inappropriate all the way around other than a few excellent nurses who actually have family members with FMS and I also had one roomate for 1 1/2 days who was also a Fibro sufferer for the past 25 years who gave me great comfort and help. As well as my best friend who is a case Mgr. at this Hospital who actually had 2 Dr's and one Nurse Practitioner written up for the shoddy way they treated me. So it definitely pays to 1) Try to go to a hospital where at least one of your own Dr's works. 2) Do follow the instructions above "If" as the other poster notated anyone involved in your surgery or procedures will listen. I did have a kind Surgeon and anesthesiologist as for the rest of the Dr's they were for the birds! And I am now paying a big price for the shoddy care and lack of my own medication regime being followed by these Dr's. But am very grateful for the above information and will take it with me "If" there's a next time for sure so thank you!!!
Reply Reply

Sounds wonderful if Doctors Follow
Posted by: crumpton
Jul 18, 2009
I had a hysterectomy in 2007. I asked the anesthesiologist about care for a patient with Fibro/CFS. Advised the surgeon and anethesiologist of all my meds which included Methadone 5mg as a long acting pain medication and Lortab 7.5 for breakthru pain that my pain managenment dr has prescribed for several years. Needless to say, my medication tolerance is high. After surgery I was given the standard IV pump which did nothing to alleviate my pain. I was crying and bundled up in pain, my urine was bloody and the nurses were concerned enough to call the surgeon back to the hospital. He acted like what was the big deal! No problem, but he did give a different medication that did help. All of this could have been avoided if the Dr's had talked to my pain management Dr. as I asked them too. I know Dr.'s are busy but please listen to Us!!! I also took a copy of the article. What would I do next time? - Have my pain management Dr. call the surgeon and talk to him. He knows me better than anyone. Then follow up to see if it had been done. I tend to expect medical personnel to be God-like and assume they will do what has been discussed and know all. Next time I will speak up more for myself. No More surgery for me unless it is life or death!
Reply Reply

Surgery and FM
Posted by: fld
Jul 31, 2009
Thanks for this heads up. I plan nasal surgery on Aug 24 so this article is timely.
Reply Reply

Great Information ~ A MUST READ for patients with FMS/CFS/ME
Posted by: nixon
Aug 3, 2009
Last year I had 2 cancer related surgeries and a hysterectomy also during my 2nd surgery. I suffer with FMS (diagnosed), & CFIDS ( undiagnosed), I was smart enough to go ahead & take my " normal " pain meds before I went to the hospital. My Gynecological Oncologist is familiar with my conditions. I WISH that I would have seen these articles beforehand, it may have POSSIBLY helped some ? May not....... My Doc was good, at prescribing extra pain meds for me, although I STILL suffered with the dreaded after-surgery flare. I've noticed that it did take me longer to heal, I'm in a group with other women dealing with the same types of Gynecological issues. Those who don't have Fibro, Immune Disorders, etc. DO HEAL quicker than us with these conditions. After my 2nd surgery I was receiving IV Morphine~ It didn't work one bit ( that was 1 of my daily FMS meds), but my hubby tracked down my GYN/ONC and was able to get them give me a stronger IV drug ! Thank Goodness, I would have never made it through the pain without it ! Anyhow~ If there is a NEXT SURGERY......I will be armed with these articles ! Thank You !!
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