What to Know About Going in for Surgery With Fibromyalgia

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The fear of pain worsening in fibromyalgia patients can be a big deterrent to surgery, but it doesn’t have to be. People with fibromyalgia can still have surgery, even elective surgery, whether it be for a knee replacement, a cosmetic procedure, or something else.

“It is not a contraindication to have surgery,” says Gordon A. Starkebaum, M.D., emeritus professor of medicine in the division of rheumatology at the University of Washington in Seattle. “One just has to realize that because people with fibromyalgia have higher intensity pain, that post-op may be more painful. Recovery period may be longer. There is the risk that pain may be somewhat worse after surgery. But it doesn’t exacerbate the fibromyalgia condition by itself.”

If the idea of pain is frightening, Dr. Starkebaum says it may help patients to call on past experience. “People with fibromyalgia must have had some experience with surgery. That experience should help them predict what it is gong to be like,” he says. “Like going to the dentist and getting a root canal.… Or, like childbirth, it’s painful, but mothers get through it all the time,” he adds.

Dr. Starkebaum says guided imagery can help, which is putting oneself in another place, or imagining something pleasant. Guided imagery is a mind-body practice that the National Center for Complementary and Integrative Health says has some research to support that it may decrease pain and fatigue symptoms in those with fibromyalgia.

“People with fibromyalgia need to know that the cause of pain is often mixed, says Dr. Starkebaum. One example is an arthritis patient who also has fibromyalgia. “If you have surgery, it depends on what is going on. If you are having a knee replacement [and the knee] has osteoarthritis, it may improve the pain from that knee, and it may not affect the rest of your fibromyalgia. Sometimes fibromyalgia is driven by pain in one place, but sort of becomes generalized,” says Dr. Starkebaum.

Pain Flares

While surgery shouldn’t exacerbate the fibromyalgia in general, there are incidences of short-term flares after other more benign procedures.

The Arthritis Foundation describes a circumstance where a patient with rheumatoid arthritis and fibromyalgia experienced a flare of both conditions for a few days after dental cleanings.

Rheumatologist Daniel Clauw, M.D., explained that anxiety, discomfort from the procedure, and immune system stimulation from the procedure itself may have contributed to the flare.

Medications and Fibromyalgia

There are several drugs approved to treat fibromyalgia, some which work by affecting brain chemicals that control pain levels, like duloxetine (Cymbalta), or some that affect nerve cells involved with pain transmission, such as gabapentin (Neurontin).

Dr. Starkebaum says that most drugs used to treat fibromyalgia have no particular surgical interaction. “That is to say they don’t prolong wound healing or bleeding, like you would stop aspirin or ibuprofen before surgery. They don’t particularly have a wash out period. So if they were held during surgery, there wouldn’t be a withdrawal necessarily or a long time to get rid of them. One exception would be narcotics, which I don’t recommend for fibromyalgia,” says Starkebaum.

The American College of Rheumatology also does not recommend narcotics for fibromyalgia and cautions that these drugs may cause “greater pain sensitivity or make pain persist,” with the exception of Tramadol (Ultram), used to treat fibromyalgia pain over a short period of time.

“If you are on narcotics, then that has to be taken into account,” says Dr. Starkebaum. “The surgeon and anesthesiologist need to be aware of it.” Because patients get narcotics after surgery, he says the usual dose of post-surgical narcotics may not be enough for these patients and their dose may need to be adjusted.

Fibromyalgia Patients with Sleep Apnea

Most people with fibromyalgia have sleep problems. Another concern after surgery is a sleep condition that may coincide with fibromyalgia.

“Sometimes people with fibromyalgia have sleep apnea, and they need sleep apnea CPAP machines,” says Dr. Starkebaum. “One thing to keep in mind—if that is the case—is that people who have sleep apnea may be more sensitive to anesthetics or pain medicines post surgery. They should definitely let their doctors know. And a lot of times, it will be necessary for them to bring their CPAP to the hospital so that they continue that at night after surgery.”