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Abstract
Fibromyalgia is a common musculoskeletal syndrome characterized by chronic widespread pain and other systemic manifestations, which has demonstrated a contribution to higher postoperative analgesic consumption to other surgeries such as hysterectomies and knee and hip replacements. The aim of this review is to search current literature for studies considering the impact of fibromyalgia on clinical outcomes of patients undergoing shoulder surgery. A systematic literature review was conducted in PubMed/Medline, Embase, and ClinicalTrials.gov in February 2019. Studies were selected based on the following participants, interventions, comparisons, outcomes, and study design criteria: adult patients undergoing surgery for shoulder pain (P); diagnosis of fibromyalgia (I); patients without fibromyalgia (C); outcome of surgery in terms of pain or analgesic or non-steroidal anti-inflammatory drugs consumption (O); case series, retrospective studies, observational studies, open-label studies, randomized clinical trials, systematic reviews and meta-analyses were included (S). Authors found 678 articles, of which four were found eligible. One retrospective study showed that patients with fibromyalgia had worse clinical postoperative outcomes; two retrospective studies reported a higher opioid prescription in patients with fibromyalgia and one prospective observational study found that a higher fibromyalgia survey score correlated with lower quality of recovery scores two days after surgery. The scarce and low-quality evidence available does not allow confirming that fibromyalgia has an impact on postoperative outcomes in shoulder surgery. Future studies specifically focusing on shoulder surgery outcomes may help improvement and personalization of the management of patients with fibromyalgia syndrome (PROSPERO 2019, CRD42019121180).
Highlights
Fibromyalgia is a musculoskeletal syndrome characterized by chronic widespread pain and systemic manifestations such as fatigue, non-refreshed sleep, mood disturbance, and cognitive impairment, causing a high impact on health-related quality of life (HRQoL) [1,2]
One retrospective study showed that patients with fibromyalgia had worse clinical postoperative outcomes; two retrospective studies reported a higher opioid prescription in patients with fibromyalgia and one prospective observational study found that a higher fibromyalgia survey score correlated with lower quality of recovery scores two days after surgery
Fibromyalgia may be a cause of failure in the treatment of concomitant painful shoulder
Summary
Fibromyalgia is a musculoskeletal syndrome characterized by chronic widespread pain and systemic manifestations such as fatigue, non-refreshed sleep, mood disturbance, and cognitive impairment, causing a high impact on health-related quality of life (HRQoL) [1,2]. The pathogenesis of fibromyalgia seems to be due to the complex interaction of the “central sensitization”. The “central sensitization” is the increased responsiveness of neurons of the central nociceptive pathways by low-threshold, non-noxious inputs such as pressure and temperature [5,6]. The “peripheral sensitization” is the reduction of threshold and the increase in responsiveness of the peripheral nociceptors probably associated with a reduction in epidermal small-fiber density [7,8]. Patients with fibromyalgia report more pain than normally expected based on the type or degree of stimulus [2,5]
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