Tips for Surgery with Fibromyalgiaby Karen Lee Richards Patient Advocate
If you have fibromyalgia and are facing a surgical procedure, you may have heard horror stories about post-operative flare-ups and long, painful recovery periods. While it’s true your recuperation period may take longer than that of the average person, there are steps that can be taken to reduce your pain levels and minimize your chances of a severe flare.
Fibromyalgia specialist's guidelines
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.
Talk to your doctors
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.
Understand pain amplification
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 a soft neck collar
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.
IV arm placement is important
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.
Avoid succinylcholine drug
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.
Pre-operative pain medication
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.
Request local anesthetic for incision
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.
Post-operative pain medication
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).
Post-operative physical therapy
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.
Following surgical guidelines does make a difference
For a firsthand account of how applying these guidelines can significantly improve your surgical recovery experience, read “Facing Surgery with Fibromyalgia.”