Study Questions Arthroplasty for Fibromyalgia Patients

Researchers who studied the pain scores of 635 patients with self-reported fibromyalgia-like symptoms concluded that total hip or knee replacement may not be advisable for those who are experiencing severe hip and/or knee pain.

As reported by Rosemary Frei, writing for Pain Medicine News, the study found that patients’ self-report survey for the assessment of fibromyalgia was the only statistically significant predictor of patients who went on to experience long-term postoperative pain. These patients also had more dire preoperative characteristics as well as experiencing more anxiety.

Daniel Clauw, M.D., director of the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor, had found in a previous study that patients’ self-reported higher scores predicted increased opioid consumption during their postoperative period. The outcome of the study led some of the researchers to speculate that the survey “may have value in screening for appropriateness for arthroplasty.”

Other doctors disagreed. Chad Boomershine, M.D., who specializes in the care of people with fibromyalgia, expressed concern that clinicians, reading the study report, might decide that fibromyalgia patients may not be appropriate candidates for knee or hip replacement.

Frei quoted Boomershine, who is assistant clinical professor of medicine at Vanderbilt University School of Medicine, in Nashville, Tennessee, as saying, “I have personal experience with many fibromyalgia patients who have arthroplasty and do quite well, but they offer special challenges. I think this screening would be valuable for identifying patients who should be targeted for better management after surgery and not used to weed out patients to avoid operating. They just need more support and better management after surgery to ensure they have good outcomes.”

Lead study author Chad Brummett, M.D., director of clinical anesthesia and research director of pain research in the Department of Anesthesiology, Division of Pain Medicine, at the University of Michigan Medical School in Ann Arbor, told Frei that “he and his colleagues would like to start doing brain imaging on this cohort to see how these patients’ postoperative pain scores correlate with abnormalities in the central nervous system.”