Tips for Surgery with Fibromyalgia

The following guidelines have been recommended by the Fibromyalgia Information Foundation, founded by Dr. Robert Bennett and Dr. Sharon Clark along with their colleagues at Oregon Health and Science University. You may want to print copies of the FIF guidelines (Guidance for Fibromyalgia Patients who are having Elective Surgery) to share with your surgeon and anesthesiologist.

Discuss the fact that you have fibromyalgia with your surgeon and anesthesiologist about two weeks before you are scheduled for surgery. The American Society of Anesthesiologists recommends that all herbal medications be discontinued two to three weeks before an elective procedure.

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, also known as central sensitization (see "Understanding Pain and Pain Amplification").

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.

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.

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.

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. Two to three grams of magnesium sulfate given intravenously over a period of 45-60 minutes has also been recommended to minimize central sensitization.

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.

Postoperatively you will need more, and usually a 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).

Postoperatively you will 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.

For a firsthand account of how applying these guidelines can significantly improve your surgical recovery experience, read “Facing Surgery with Fibromyalgia.”