Fibromyalgia is considered the quintessential pain syndrome. The pain is unrelenting, difficult to treat and isn’t caused by some obvious structural defect.
A Michigan research group following arthritis patients undergoing hip or knee replacement or remodeling has found you don’t need to have full-blown fibromyalgia to have major pain problems – you just need to have something like it.
Like others in the field, they noticed that surgical outcomes often do not track what they see on their scans. Some patients with major structural problems are in less pain than patients with minor structural problems. Some patients with apparently successful surgeries aren’t have successful outcomes. Even after alleviating their structural problems some patients pain levels are still so high that their surgeries declared failures.
Something other than knee or hip damage is impacting these patients. That something appears to be a ‘proto-fibromyalgia’ state; not full-blown fibromyalgia but a lesser form of it.
Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Brummett CM, Urquhart AG, Hassett AL, Tsodikov A, Hallstrom BR, Wood NI, Williams DA, Clauw DJ. Arthritis Rheumatol. 2015 Mar 13. doi: 10.1002/art.39051.
This study took almost 500 arthritis patients who were undergoing knee or hip replacement or remodeling and assessed their level of fibromyalgia-like symptoms. They removed everyone from the study who had fibromyalgia and then followed the rest of them for six months. At the end of that period, they asked them about their pain.
What they found was shocking. The patients with proto- fibromyalgia – the ones who didn’t have FM but scored higher on the FM questionnaires – started out in more pain and stayed that way. Usually, patients in the most pain receive the most relief from surgery, but the proto-FM patients received less, nor more relief from surgery, than the other patients.
The fibromyalgia severity scores predicted with a very high degree of accuracy (p<0.00001) the patients who were not going to improve much after surgery. Even patients who didn’t come close to meeting the criteria for fibromyalgia suffered from increased pain. The scores also predicted which patients for whom the surgery was deemed a failure.
“However, these data suggest that in some individuals with arthritis….. this … pain amplification is clinically relevant and might even be playing a more prominent role in a given individual’s overall pain experience”
The increased pain these proto-FM patients were in didn’t surprise this research group. A former study indicated that arthroplasty patients with a tendency towards fibromyalgia needed more opiates post-surgery than people without a tendency towards fibromyalgia. The same was true of women undergoing hysterectomies. If you have FM-like symptoms you’re probably going to experience more pain than usual after surgery.
Catastrophizing or depression or neuropathic pain were not the issue. These factors contributed toward poor pain outcomes in only minor ways. The best predictor of having higher amounts of pain after surgery was simply having FM-like symptoms.
The authors concluded the post-surgery patients in increased pain were probably suffering from central nervous system driven pain sensitization. In other words, you don’t need to have fibromyalgia to have central nervous system sensitization.
When those patients show up complaining about pain and asking for more pain drugs surgeons across the country are undoubtedly looking at their scans and shaking their heads. They’re labeling them with depression, anxiety or hysteria but the surgeon’s are looking in the wrong place. The problem was not in their knees. It was in their central nervous system.
These are not uncommon findings. Millions of people with poor surgical outcomes are undoubtedly getting inadequate or even harmful treatments and experiencing being ostracized. These patients are showing up again and again looking for relief. Their suffering aside, they’re surely a huge drain on the medical system.
The National Institutes of Health Missing the Boat – Again
The answer to these proto-fibromyalgia patient’s problems clearly lies in understanding fibromyalgia, yet the NIH continues to treat fibromyalgia as if it was a minor problem.
Like chronic fatigue syndrome (ME/CFS), fibromyalgia receives amongst the lowest funding levels of any disorder at the NIH. In fact, per patient funding for fibromyalgia ($1/per patient per year) is substantially less than for ME/CFS (@$5/per patient/per year.)
This study and others indicate, however, that “fibromyalgianess” probably plays a role in many chronic pain conditions. The authors stated their findings have “enormous economic implications”.
The NIH says they’re dedicated to improving the health of all Americans, but by essentially ignoring FM they’re ignoring the plight of many other Americans in pain.
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