Pain Management for Fibro Patients During Surgery

Surgery is necessary. But surgery can also cause a lot of pain and stress for a patient, especially if they have fibromyalgia.

Fibromyalgia, or fibromyalgia syndrome (FMS), is a health condition characterized by chronic musculoskeletal pain. Someone with fibromyalgia typically experiences general fatigue, trouble sleeping, anxiety and pain in areas of tenderness or trigger points.

It is a known fact that both stress and physical trauma can exacerbate fibromyalgia symptoms, especially if surgery is in the picture. With surgery, you typically have a long period of recovery, which can lead to several "fibro-flares" in post-op.

We have a gathered some guidelines for fibromyalgia patients who are planning to undergo surgery. If you have questions or concerns, it's important to bring them up with your doctor or surgeon.

Fibromyalgia and surgery: The recovery time for patients can be a lot longer

Fibro patients aren't exempt from surgery, however, patients should be aware that the pain may be worse after the surgery and the recovery may take a little longer. Patients and doctors should also be aware that oftentimes the cause of the pain is mixed.

One example is a patient with fibromyalgia whose knee has osteoarthritis and will need to have a  knee replacement. The pain from the knee may improve but will not have an effect on the symptoms of fibromyalgia. This means that the pain is driven to one place but sometimes it can become generalized.

While surgery might be scary and a major concern for fibromyalgia patients , there are a few guidelines to consider that can help in minimizing the chances of a fibro flare after surgery.

Going under the knife? Consider these guidelines with your surgeon

1. Discuss the condition with both the surgeon and anesthesiologist at the pre-surgery meeting.

2. A fibromyalgia patient can request opioid pain medication at least 90 minutes before the operation. An opioid is a morphine drug that can minimize the central nervous system's sensitization – as this can only worsen the pain the patient is suffering.

3. The patient can ask the anesthesiologist for a long-acting local anesthesia on the incision. This is to minimize pain signals to reach the spinal cord and brain that can trigger central sensitization.

4. Magnesium sulfate can be given intravenously for a period of 45 - 60 minutes. This can block central sensitization.

5. Depending on the nature of the surgery, doctors may request the patient to discontinue some medications and supplements prior to the surgery.

6. During surgery, the patient may be put in a position that can strain the muscles. Ask the caregivers to position the arm with the intravenous line to be placed near the body, not away from the body or over the head.

7. If an endotracheal tube is to be used during the procedure, the patient can request for a soft neck collar to minimize neck hyperextension. 

8. A person with fibromyalgia may experience sensitivity to anesthesia and muscle relaxants, which are often used in a surgery. Muscle relaxants like succinylcholine may cause postoperative myalgia and can complicate recovery. To prevent this problem:

• Talk to the doctor about any drug-related allergies or sensitivities.
• Discuss the medications that can be of help in reducing post-surgical pain.
• Doctors may use a histamine-releasing anesthesia if any drug allergy is present.

9. Low plasma volume on fibromyalgia patients may experience dehydration after the surgery. This may lead to vasovagal syncope – low blood pressure that may cause fainting and dizziness. The patient must be well-hydrated before and after the surgery.

10.  Optimal pain management is necessary right after the procedure. The standard post-surgical pain medications that are prescribed by the physician may not be enough to get through the recovery. More often, fibromyalgia patients need to use pain medications after surgery.

Opioid medications are usually given a few days after the surgery. A patient-controlled analgesia (PCA) pump may be used to continuously deliver a certain amount of pain medication. If necessary, stronger pain medications may be given for both hospital and home use.

11.  Sleep disorders like insomnia should be addressed with the doctor prior to the surgery. This could cause a serious problem, especially when under anesthesia. Continuous positive airway pressure (CPAP) machine can be used during the procedure, if a patient suffers from sleep apnea.

12.  Slow healing is usually expected after the surgery, especially for patients with fibromyalgia. While it will be a lengthy process, the patient may prepare for this by:

• Knowing who will take care of the patient after the surgery
• Allowing enough time off work, and the length of time needed for the recovery
• Stocking up on supplies that may be needed post-surgery, especially medications for flare-ups
• Resting and allowing the body enough time to heal and recover

Post-Op: For fibro patients, the pain is inevitable

For a person with fibromyalgia, surgery may cause trauma to the muscle and skin. The pain is inevitable. It is important that proper care and comfort is given to the patient, especially after the surgery.

To reduce the pain, fibromyalgia patients may be advised to minimize unnecessary movements post-surgery.

The Fibromyalgia Information Foundation suggests that gentle stretching may be done once the incision is healed. This is to help in rehabilitating the muscles. Also, physical therapists may help in the patient's full recovery.

No one can promise a pain-free surgery, especially for fibromyalgia patients. It can be comforting to have a family member who will help the patient get through the process. As long as there is someone to provide comfort, a fibromyalgia patient will remain strong, and there is a bigger chance that they can gain their physical health faster.