Guidance for Fibromyalgia Patients
who are having Elective Surgery

 If you are having a major surgical procedure there are some issues that you may wish to discuss with your surgeon and anesthesiologist that could reduce the "fibro-flare" that often occurs after surgery in fibromyalgia patients. While no one can promise you a pain-free surgical experience, patients whose surgeons and anesthesiologists have taken into account the following issues are likely to have a better postoperative experience.

1. Discuss the fact that you have fibromyalgia with your surgeon and anesthesiologist about 2 weeks before you are scheduled for surgery. The American Society of Anesthesiologists recommends that all herbal medications be discontinued 2 to 3 weeks before an elective procedure.

2. Pain after surgery is inevitable, because all surgeries result in trauma to the skin and muscles. This post-surgical pain is usually accentuated in fibromyalgia patients due to enhanced pain processing (see central sensitization).

3. 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 your are unconscious.

4.  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 your are unconscious.

5. 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.

6. Request that you be given a pre-operative opioid pain medication – about 90 mins. 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.

7. 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 accentuate central sensitization.

8. Postoperatively you will need more, and usually 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).

9. 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.