Fibromyalgia: A primer for the anesthesia community – Source: Current Opinion in Anaesthesiology, July 27, 2011

[Note: Dr. Clauw is a leader in the study of fibromyalgia pain and related pain states. At the September 2011 IACFS/ME Conference in Ottawa, he will review research on the different underlying mechanisms of fibromyalgia pain, and how analgesia can be ‘personalized’ to reflect these differences. He will also explain his view that the tender point count is no longer necessary to diagnose FM. Those facing surgery may suggest their medical team access the full text of this fee-based article.]

Purpose of Review: The present review is intended to give an overview of fibromyalgia for the anesthesiologist. While the basics of the treatment of fibromyalgia are included, the intent is to provide context to discuss the potential implications in perioperative [before surgery] management.

Recent Findings: Research continues to demonstrate that fibromyalgia patients have neurophysiologic abnormalities that alter sensory perception, including lower levels of central neurotransmitters associated with the inhibition of pain and higher levels those that facilitate pain.

While comorbid mood disorders are more common in fibromyalgia patients, studies have shown that fibromyalgia symptoms are not explained by depression alone.

In the last year, the American College of Rheumatology established a new self-report questionnaire for the diagnosis of fibromyalgia in lieu of the previously required tender point examination plus self-report questionnaire.

This questionnaire allows for the study of the severity of sensitivity and symptomatology on a continuum, which is termed ‘fibromyalgianess’.

Some new concepts in the treatment have been proposed, including sodium oxybate, transcranial magnetic stimulation, and web-based cognitive behavioral therapy.

The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed.

Source: Current Opinion in Anaesthesiology, July 27, 2011. PMID: 21799404, by Brummett CM, Clauw DJ. Departments of Anesthesiology, Internal Medicine (Rheumatology) and Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA.

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