HIGH INCIDENCE OF FIBROMYALGIA IN PATIENTS WITH FAILED BACK SURGERY SYNDROME Esther Caballero-‐‑Manrique and Carlos A. Pino Department of Anesthesiology, University of Vermont Medical Center.
Introduction Fibromyalgia (FM) the prototypical disease of centralized pain. It has been shown that patients with FM or FM-symptoms have less improvement after orthopedic procedures such as knee and hip replacements. [1] Our hypothesis is that , similarly to knee or hip surgery, back surgery is likely to be ineffective in patients who suffer back pain due to an aberrant centralized process (regardless of the presence of an underlying pathology, which can be asymptomatic).
Proportion of patients with Failed Back Surgery Syndrome with and Without Fibromyalgia FM 25%
No FM 75%
Objective
To find the association between fibromyalgia and Failed Back Surgery Syndrome (FBSS).
Materials and Methods
Number of patients subdivided in low, middle and high number of surgeries
After obtaining Institutional Review Board approval, we conducted a retrospective study of all patients seen in The University of Vermont Medical Center from January 1, 2010 through December 31, 2015 searching for FBSS and, within this group, FM. The total number of surgeries per patient was also quantified, and the surgical procedures were classified according to type. ICD-9 and ICD-10 codes were used to search for all diagnoses.
Results
1 Pearson
Demographic Characteristics of patients with FBSS with and Without FM
Mean Age p = 1
N of females (% female)
BMI (Kg/m2)
Smoker (% smoker)
p=0.6
p = 0.18
p = 0.02
PaAents with FM N=98
54.9 (13.1)
PaAents without FM 54.8 (14.1) N=292
54 (55.1%)
30.5 (6.8)
18 (18.4%)
121 (41.4%)
30.1 (6.2)
73 (25.0%)
1-‐3 surgeries p = 0.0041
4-‐7 surgeries p = 0.0051
PaAents with FM, N=98 PaAents without FM , N=292
50 (51.0%)
42 (42.9 %)
More than 7 surgeries p = 0.0021 6 (6.1 % )
203 (69.5%)
77 (26.4 %)
12 (4.1%)
Chi square value
Total number of surgeries divided into categories Type of surgery
Back Neck Lower Ext Upper Ext Gyn Mandibular Other Joint Total
PaAents with FM (surgeries per 100 paAents)
PaAents without FM p value (surgeries per 100 paAents)
197 (201) 18 (18) 41 (42) 46 (47) 46 (47) 0 (0) 30 (31) 378 (390)
510 (180) 35 (12) 113 (39) 99 (34) 88 (30) 4 (1) 39 (13) 888 (304)
Conclusions o Association between FM and FBSS is significant, with 25% of FBSS patients having a diagnosis of FM versus 1.75% in the general population. [2] o Patients with FM have more (a larger number of )surgeries, in a larger variety. o Some patients with central sensitization undergo a high number of procedures in an effort to decrease their symptoms. Yet, given the central, rather than peripheral cause of their pain, surgeries are less likely to meet expectations. o Surgery can lead to worsening pain as acute phase nociceptors lead to neuroplasticity with decrease of inhibitory neurons and increase in nociceptive signals. [3] o The impact of FBSS is tremendous, with direct costs ranging between $30,000-40,000 per patient, [4] high incidence of disability, decreased quality of living, and unemployment. Given increasing rates of lumbar surgeries and high rates of failure, it is critical to identify patients with FM prior to surgery and educate them regarding worsening symptoms and realistic expectations.
References 0.09 0.1 0.7 0.07 0.01 0.001 < 0.005
**All pa:ents in this group had at least one back (thoracic or lumbar) or neck (cervical) surgery performed. Pa:ents with FM have significantly higher number of surgeries for “other joint” and total number of surgeries. **Surgical procedures included in this table are orthopedic, spine, gynecological, and mandibular.
1. Brummett, C.M., Urquhart, A. G., Hassett, A. L., Tsodikov, A., Hallstrom, B. R., Wood, N. I., Williams, D. A. and Clauw, D. J., Characteristics of Fibromyalgia Independently Predict Poorer Long-Term Analgesic Outcomes Following Total Knee and Hip Arthroplasty. . Arthritis & Rheumatology, 2015. 67: p. 1386-1394. 2. Walitt B, N.R., Katz RS, Bergman MJ, Wolfe F. , The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey. PLoS ONE, 2015. 10(9): p. e0138024. 3. Voscopoulos C, L.M., When does acute pain become chronic? Br J Anaesth, 2010. 105(Suppl 1): p. 69-85. 4. North RB, K.D., Shipley J, Taylor RS., Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery, 2007. 61(2): p. 361-368.
UVMHealth.org/MedCenter
