Fibromyalgia and Surgery
If you have fibromyalgia and are facing a surgical procedure, you may be more concerned than the average patient because you have heard stories about post-operative fibro flares and long, painful recovery periods. While it's true your recuperation period will likely be a little longer than it would be for most people, there are steps that can be taken to reduce your pain levels and minimize your chances of a severe flare.
Take these suggestions with you and discuss each item with both your surgeon and your anesthesiologist at your pre-surgical meeting. Don't wait until the day of your surgery to bring them up. Ideally make a copy to give to each that can be kept in your file. Do not assume that they know how to deal with fibromyalgia patients. It may not be something they come across very often in their practices.
Precautions for Fibromyalgia Patients Having Surgery: Fibromyalgia causes "central sensitization" which results in pain amplification. The precautions suggested below are all designed to prevent triggering the central sensitization process.
Ask that you be given pre-operative opioid pain medication about 90 minutes before your surgery to minimize central sensitization.
Two to three grams of magnesium sulfate given intravenously over a period of 45 - 60 minutes might also block central sensitization.
Sometimes increased postoperative pain in FM patients is due to the use of a muscle relaxant drug called succinylcholine during surgery. Talk to your anesthesiologist about other options if this drug was to be used.
The arm with your intravenous line should be kept near your body, not over your head or otherwise away from your body. It's best that you not be kept in any one unusual position for any longer than absolutely necessary.
If an endotracheal tube is used to help you breathe during the procedure, care should be taken to minimize neck hyperextension. Request that you be given a soft neck collar to wear.
Request that a long-acting local anesthetic be infiltrated into your incision. Even though you won't be awake to feel it, if the area is not anesthetized, pain impulses will be sent to the spinal cord and brain, which can trigger central sensitization.
When you leave surgery, a PCA (patient controlled analgesia) pump should be in place. In most cases opioid medications should be administered during the first few days following surgery. PCA pumps allow a certain amount of medication to be delivered continuously, with the added feature of letting the patient add extra medication at pre-set intervals as needed. As a fibromyalgia patient, you will probably need more post-operative medication than most and for a longer duration.
While no one can promise you a pain-free surgical experience, patients whose surgeons have worked them and followed these procedures report a better recovery experience than they had anticipated.
Sources: "Guidance for Fibromyalgia Patients Who Are Having Elective Surgery. Oregon Fibromyalgia Foundation. 2002. Squires, Sharon. "Some Important Considertions for Fibromyalgia Patients About to Have Surgery." National Fibromyalgia Association. 2003
© Karen Lee Richards Updated: 6/16/08