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Fibromyalgia Surgery Protocol


By Karen Lee Richards*

Having surgery is a concern for anyone but it can be especially concerning for people who have fibromyalgia because of their problem with pain amplification, also known as central sensitization. There are, however, steps that can be taken before, during and after surgery that may reduce the “fibro-flare” that often occurs after surgery in fibromyalgia patients.

The following guidelines have been recommended by the Fibromyalgia Information Foundation (founded by Drs. Robert Bennett and Sharon Clark and their colleagues at Oregon Health & Science University). You may want to print copies of these guidlines to share with your surgeon and anesthesiologist.

  1. Discuss the fact that you have fibromyalgia with your surgeon and anesthesiologist about 2 weeks before you are scheduled for surgery. The American Society of Anesthesiologists recommends that all herbal medications be discontinued 2 to 3 weeks before an elective procedure.
  2. 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 “Understanding Pain and Pain Amplification” – also known as central sensitization).
  3. 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.
  4. 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.
  5. 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.
  6. Request that you be given a pre-operative opioid pain medication – about 90 mins. 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.
  7. Two to three grams of magnesium sulfate given intravenously over a period of 45 – 60 minutes has also been recommended to minimize central sensitization.
  8. 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.
  9. Postoperatively 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).

* Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE, the very first full-color, glossy magazine devoted to FM and other invisible illnesses. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.

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