Pain in People With Fibromyalgia Syndrome (FMS) Undergoing or Following Surgery: A Systematic Narrative Review

TL;DR

This review examines how people with fibromyalgia experience pain and recovery after surgery, finding they may face more pain and complications than others.

Contribution

The study provides a systematic narrative review of perioperative outcomes in fibromyalgia patients undergoing surgery.

Findings

FMS patients may experience more acute postoperative pain and increased widespread spontaneous pain.

Opioid requirements are higher in FMS patients and linked to symptom severity.

Treating visceral pain sources may improve FMS pain and sensory thresholds beyond 3 months.

Abstract

Fibromyalgia syndrome (FMS) is a chronic pain condition characterised by widespread pain, fatigue, sleep disturbance and cognitive problems. This systematic review aimed to characterise the perioperative experiences of FMS patients undergoing elective surgery, including pain, local anaesthetic (LA) efficacy, complications, and functional outcomes postoperatively.

This systematic review was reported in accordance with the PRISMA guidelines. The protocol was registered on PROSPERO (CRD: 42022309297). MEDLINE, Embase and CENTRAL were searched from 1990 to 28 June 2024. Two reviewers independently undertook screening, data extraction and quality assessment. A narrative synthesis was conducted.

Nineteen relevant studies published between 1999 and 2024 were identified, mostly focussing on orthopaedic surgeries. Evidence suggests FMS patients may experience more acute postoperative pain at the surgical site and increased widespread spontaneous pain compared to non‐FMS individuals. Opioid requirements may also be greater and is linked to the extent of symptomatology. Little data existed on the benefit of LA techniques. Large cohort studies found no overall increase in complications, but within FMS patients undergoing orthopaedic surgery, there were increased 30‐ and 90‐day complications including anaemia, readmissions and pneumonia. Data indicate poorer early postoperative functional recovery in FMS patients. Interestingly, some studies reveal that treating perpetuating visceral pain sources may lead to improvements in spontaneous FMS pain and sensory thresholds beyond 3 months.

The review highlights a paucity of evidence characterising the immediate perioperative course in FMS patients, indicating an important area for future research to optimise patient experiences and outcomes; however, individualised patient discussions are key.

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