Fibromyalgia: a primer for the anesthesia community

Abstract

Purpose of review: The present review is intended to give an overview of fibromyalgia for the anesthesiologist. While the basics of the treatment of fibromyalgia are included, the intent is to provide context to discuss the potential implications in perioperative management.

Recent findings: Research continues to demonstrate that fibromyalgia patients have neurophysiologic abnormalities that alter sensory perception, including lower levels of central neurotransmitters associated with the inhibition of pain and higher levels those that facilitate pain. While comorbid mood disorders are more common in fibromyalgia patients, studies have shown that fibromyalgia symptoms are not explained by depression alone. In the last year, the American College of Rheumatology established a new self-report questionnaire for the diagnosis of fibromyalgia in lieu of the previously required tender point examination plus self-report questionnaire. This questionnaire allows for the study of the severity of sensitivity and symptomatology on a continuum, which is termed 'fibromyalgianess'. Some new concepts in the treatment have been proposed, including sodium oxybate, transcranial magnetic stimulation, and web-based cognitive behavioral therapy.

Summary: The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed.

Figure 1. Updated American College of Rheumatology survey criteria for fibromyalgia

The new ACR survey for FM with the 19 potential body areas and the symptom assessment. Scores can range from 0-31, and patients are asked whether the symptoms have been present at nearly the same level for the last 3 months or more. The presence of pain for 3 months or more with a score ≥ 13 meets the survey criteria for FM. (Adapted from Wolfe, F., et al., The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken), 2010. 62(5): p. 600-10 with permission)

Figure 2. Glutamate levels in the posterior insula are negatively correlated with experimental pressure pain testing

Medium pressure thresholds from fibromyalgia patients (solid circles) and control patients (open circles) are displayed in this scatterplot, along with a regression line across both groups. Fibromylagia patients demonstrated higher central glutamate levels and corresponding lower pain thresholds; however, the correlation between higher glutamate levels and lower pain thresholds was also demonstrated in the control group. Glx = glutamate (From Harris, R.E., et al., Elevated insular glutamate in fibromyalgia is associated with experimental pain. Arthritis Rheum, 2009. 60(10): p. 3146-52 with permission)