Surgeries in Fibromyalgia
“It is not a contraindication to have surgery,” says Gordon A. Starkebaum, M.D., emeritus professor of medicine in the division of rheumatology at the University of Washington in Seattle. “One just has to realize that because people with fibromyalgia have higher intensity pain, that post-op may be more painful. Recovery period may be longer. There is the risk that pain may be somewhat worse after surgery. But it doesn’t exacerbate the fibromyalgia condition by itself.”
Concern when facing surgery
Fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) both can be exacerbated by physical trauma. It’s common for people with these conditions to be especially concerned when facing surgery. They’re generally worried that their condition(s) are likely to flare afterward, which may complicate recovery.
So far, we have very little research-based knowledge of the impact of surgery on FMS or ME/CFS or how our symptoms impact the recovery process. However, a couple of researchers have put together recommendations for us based on their knowledge of the conditions and what they’ve observed in their patients.
These experts are The Fibromyalgia Information Foundation, which was founded by researchers at Oregon Health & Science University, and Charles W. Lapp, MD, who founded the Hunter-Hopkins Center in Charlotte, NC, which specializes in FMS and ME/CFS.
Surgery, with or without anesthesia, weakens a fibromyalgia sufferer
Surgery, with or without anesthesia, weakens a fibromyalgia sufferer already prone to infection with a decreased immunity and represents an added stress that will make the fibromyalgia worse. Not only the rate of complications increases but also the fibromyalgia itself worsens.
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This is why if any surgery is suggested a second opinion that should be sought and a full discussion on the possible alternatives, especially conservative treatments, should take place. No surgery should be done without this full discussion.
Tips for Surgery with Fibromyalgia
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.
Succinylcholine is a Bad Idea
If you want to avoid postoperative pain amplification, you will need to stay away from the muscle relaxant known as succinylcholine, which is commonly used in surgeries by the anesthesiologist. This drug and fibromyalgia just don’t go together, so talk with your anesthesiologist to work around the drug.
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.
The cause of pain is often mixed
“People with fibromyalgia need to know that the cause of pain is often mixed, says Dr. Starkebaum. One example is an arthritis patient who also has fibromyalgia. “If you have surgery, it depends on what is going on. If you are having a knee replacement [and the knee] has osteoarthritis, it may improve the pain from that knee, and it may not affect the rest of your fibromyalgia. Sometimes fibromyalgia is driven by pain in one place, but sort of becomes generalized,” says Dr. Starkebaum.
Muscle Strain from Positioning
During surgery, your body could be put in positions that may hyperextend or strain certain muscles. For example, your arm may be stretched over your head or out to the side to accommodate an IV. Suggestions for alleviating this problem include:
Asking to have your IV arm placed close to your body if at all possible. Asking whether you’ll have an endotracheal tube in your nose or mouth during the procedure, and if so, asking to wear a soft neck collar to lower the risk of your neck being hyper extended. Keep in mind that some accommodations may not be possible, depending on the nature of the surgery.
Local Anesthesia Might be Necessary
This is something only a doctor with experience regarding fibromyalgia will understand; full anesthesia alone might not be enough to counter the post-surgical pain symptoms of fibromyalgia. This is why local anesthesia is often a better option than going under a general anesthetic.
Even if it cannot be helped, consult with your anesthesiologist and tell him/her to give you a local anesthetic at the site of the surgery too because that would actively prevent central sensitization.
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.
Sleep Apnea
Most people with fibromyalgia have sleep problems. Another concern after surgery is a sleep condition that may coincide with fibromyalgia. “Sometimes people with fibromyalgia have sleep apnea, and they need sleep apnea CPAP machines,” says Dr. Starkebaum.
“One thing to keep in mind if that is the case is that people who have sleep apnea may be more sensitive to anesthetics or pain medicines post surgery. They should definitely let their doctors know. And a lot of times, it will be necessary for them to bring their CPAP to the hospital so that they continue that at night after surgery.”
Ask for a PCA Pump
PCA stands for Patient Controlled Analgesia and it’s given to patients who are suffering from extreme pain or have the potential to. It simply allows the patient to administer some additional pain-relieving opioids or other drugs, directly to her at fixed intervals and in limited amounts.
Aside from giving you at least some control over any post-op fibromyalgia-related pain, PCA pumps also provide the patient with a bit of mental confidence and a sense of control over the pain.
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.
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Reference:
- Ferre A. Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties. Neuroglia. 2016 Feb 11. pii: S0213-4853(16)00010-4. doi: 10.1016/j.nrl.2015.11.019.
- Marvisi M, Bazarini L, Mancini C, Ramponi S, Marvisi C. Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy. European journal of internal medicine. 2015 Nov;26(9):e49-50. doi: 10.1016/j.ejim.2015.06.010.
- Having Surgery With Fibromyalgia & Chronic Fatigue Syndrome By Adrienne Dellwo via VeryWell
