Background/Purpose:

Chronic pain is a major symptom for which patients undergo spinal surgery. At the same time, chronic pain is considered an entity in and of itself, often constituting part of the clinical spectrum of central sensitization (e.g. fatigue, cognitive impairment etc) thus overlapping with the fibromyalgia syndrome (FMS).

The impact of surgical intervention on chronic pain is not well known. While such interventions may remove a local “pain generator” they may simultaneously constitute a form of physical trauma, as well as entailing prolonged immobilazion, both potentially detrimental for fibromyalgia patients.

The aim of this study was to evaluate patients who undergo spinal surgery for presence of central pain and central sensitization symptoms and evaluate the correlation between these symptoms and the surgical outcomes.

Methods:

Participants were patients scheduled for spinal surgery.

Pre-surgical evaluation included physical examination and manual dolorimetry, documenting the 1990 ACR FMS classification criteria. In addition, patients filled out the widespread pain index (WPI) and the Symptom Severity Scale (SSS) which are part of the suggested 2010 diagnostic criteria of fibromyalgia, as well as the fibromyalgia-Impact Questionnaire (FIQ) and SF-36.  

Eight weeks after surgery, patients underwent follow-up evaluation.

Statistics: Spearman correlations were calculated between the pre-surgery parameters (WPI and SSS) and the change in SF-36 items. P values under 0.05 were considered significant.

Results:

Twenty eight patients (18 male, 10 female) were recruited. The average age was 56.3 (23-85). The average BMI was 26.7 kg. Three patients fulfilled ACR 1990 fibromyalgia criteria (10.7%), whereas 8 patients fulfilled the 2010 diagnostic criteria (28.6%).  Thirteen patients were available for post – surgical evaluation.

Table 1 presents the correlations calculated between the pre – surgical WPI and SSS and the change in the SF-36 domains: Physical Functioning (PF), Role – Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE), Mental Health (MH) as well as the Mental Component Score (MCS) and Physical Component Score (PCS). A significant negative correlation was observed between the WPI and the delta RP item; a significant negative correlation was also observed between the SSS and the delta of the GH and RE items.

Conclusion:

FMS symptoms were highly prevalent among patients scheduled for spinal surgery (28.6%). A negative correlation was observed between pre-surgical severity of FMS symptoms and components of the post-surgical SF-36. Patients with symptoms of FMS may have a poor outcome after spinal surgery. The clinical utility of surgical intervention in such patients should be carefully evaluated and treatment specific for FMS considered, before embarking on a surgical course.