Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes

Patients with fibromyalgia are at increased risk to experience increased and prolonged postoperative pain. In this review, we will provide an overview of pathophysiological characteristics of fibromyalgia relevant for enhanced pain processing after surgery. Furthermore, we will present some potential treatment options in the perioperative period based on specific symptoms of individual fibromyalgia patients to optimize their pain management after surgery.

Recent evidence points towards enhanced central nervous system sensitization and decreased descending inhibition in patients with fibromyalgia. Even in patients without fibromyalgia, these two mechanisms are seen as major contributors to the severity of acute and chronic pain states after surgery. Furthermore, other symptoms and comorbidities such as anxiety, depression and somatization disorder, frequently associated with fibromyalgia, are independently known to increase the risk of acute and prolonged pain after surgery. Therefore, an optimal treatment approach in the perioperative period should include substances and strategies targeting specific symptoms in fibromyalgia patients to prevent or specifically reduce acute and prolonged pain after surgery. Such multimodal pain management in fibromyalgia patients in the perioperative period should include nonopioid analgesics, gabapentinoids, antidepressants, N-methyl-D-asparate antagonists and use of regional techniques when appropriate.

The perioperative pain management of patients with fibromyalgia is challenging and should include symptom-based approaches to target enhanced central sensitization and decreased inhibition in these patients as well as their psychological syndromes aiming to decrease acute and prolonged pain after surgery.