Advice for Those Facing Surgery – An Update

Many physicians who do not specialize in management of patients with Fibromyalgia, ‘Chronic Fatigue Syndrome’ (ME/CFS), Restless Legs Syndrome, or Post-Polio Syndrome will not be conversant with the special considerations that can improve both the surgical experience and the results of surgery in these cases.

Each of the following guidelines is physician-developed and evidence-based. Each may be printed out for sharing with physicians, surgeons, nurses, and anesthesiologists, or e-mailed directly to these providers. (A final item for those with Multiple Chemical Sensitivity was compiled by an experienced patient, as so far we have found no physician-developed advice.)


Fibromyalgia: A Primer for the Anesthesia Community (July, 2011)
By Drs. Daniel J Clauw and Chad M Brummett

Drs. Clauw and Brummett, researchers at the University of Michigan Chronic Pain and Research Center, published this FM primer for anesthesiologists to share the latest insights regarding fibromyalgia pain mechanisms, measurement, and control. They also provide information and tools to guide pre-surgical assessment of the FM patient’s highly individual symptoms and sensitivities, in support of the best possible outcome. If your medical team has not reviewed this, recommend that they do.


Guidance for Fibromyalgia Patients Who Are Having Elective Surgery
By the Oregon FM Research & Treatment Team*

“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,” the team writes. To read and print out or e-mail this list of 8 guidelines, click here. (See “Article Tools” for easy printing/e-mail options.)
* This team was founded by noted rheumatologist Robert Bennett, MD, exercise physiologist Sharon Clark, PhD (co-authors of the Fibromyalgia Impact Questionnaire), and their colleagues at Oregon Health & Science University in Portland.


Recommendations for Persons with Chronic Fatigue Syndrome (or Fibromyalgia) Who Are Anticipating Surgery
By Dr. Charles W. Lapp, MD*

Dr. Lapp developed this information to reduce the risk of surgical procedures for ME/CFS/FM patients. It is evidence-based and meant to be shared with the patient’s professional healthcare team. To read and print or e-mail his 8 recommendations to your healthcare team, click here. (See “Article Tools” for easy printing/e-mail options.)

* Dr. Lapp directs the Hunter Hopkins Center for ME/CFS/FM in Charlotte, NC, and is co-author with Lucinda Bateman, MD, of a 2-hour online course on CFS Diagnosis and Management for Physicians, Nurses, and Pharmacists, developed with support from the CDC and CFIDS Association of America.


“Surgery and RLS – Special considerations for the surgical team when the patient has Restless Legs Syndrome”
By the Restless Legs Syndrome Foundation*

This brochure produced has been produced as a means of educating surgeons and anesthesiologists regarding primary features of RLS; substances that may be useful in treating RLS, substances that should NOT be given to RLS patients, and other guidelines for patient management before, during, and after surgery.

Sample excerpts:

• “A variety of drugs typically used in the perioperative period are believed to have the potential to exacerbate symptoms of RLS.”

• “Particular attention should be paid to RLS patients in the immediate postoperative period as quiescence often exacerbates the need to move. This may be severe enough to manifest as agitation…

To read, print, or e-mail this brochure in PDF format, click here.

* The Restless Legs Foundation ( is a nonprofit organization offering many resources for RLS patients and physicians who treat them, developed by an organization of professionals committed to advancing basic and clinical research on RLS.


“Summary of Anesthesia Issues for the Post-Polio Patient”
By Dr. Selma H. Calmes, MD*

Hundreds of thousands of people affected by the polio epidemic of the past century may experience post-polio syndrome – marked by fatigue, pain, and new-onset weakness thought to involve delayed deterioration of motor neuron function. When these patients require surgery, special precautions are warranted, owing to potential respiratory impairment, sleep apnea, swallowing difficulties, cold intolerance, and more. Dr. Calmes bases her list of 8 guidelines (provided also in Spanish and French) on her extensive research and clinical experience with post-polio patients. To read them, click here.

* Dr. Calmes is Chair of the Department of Anesthesiology, Olive View-UCLA Medical center, Sylmar, California, and Vice Chair of the UCLA School of Medicine Department of Anesthesiology.


“Tips for Anesthetics and Hospitalization for People with Multiple Chemical Sensitivities”
By Susan Beck*

“These are suggestions from my own experience,” writes Beck. “You must consider your own sensitivities and ask questions to make sure you are aware of and have evaluated everything being administered and have taken all possible precautions to avoid exposures.” Though this article was last updated in 2003, it may be very helpful on a subject offering so little public information. For example, advises Beck, “The first and most important point is to avoid a gas anesthetic” and “ask for the special warming apparatus which is put around your shoulders during a long surgery to keep your body temperature at a safe level.”

* Importantly, Susan Beck is not a physician but rather an experienced MCS patient. She is a moderator of the website.

Note: This information is generic and should not take the place of research and discussions in collaboration with your professional healthcare team.

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