Study Shows association between Fibromyalgia and Failed Back Surgery

A new study has found that one of four people with failed back surgery syndrome (FBSS) also have fibromyalgia (FM). The impact of FBSS is serious, costing patients around $30,000. In addition, FM and FBSS are both associated with decreased quality of life, high incidence of disability, and unemployment.

About Fibromyalgia

Fibromyalgia causes pain all over the body, which is known as widespread pain. In addition, fibromyalgia is associated with fatigue, emotional distress, and sleep problems. According to the National Fibromyalgia Association, fibromyalgia affects 10 million people in American, and around 4.5% of the world’s total population. More prevalent in women, 83% of people diagnosed with fibromyalgia are female, but it can occur in men, children, and all races.

Fibromyalgia causes widespread body pain, anxiety, sleeping problems, fatigue, memory problems, and concentration difficulties. Researchers believe the pain is associated with increased and repeated nerve stimulation in the patients’ brains. In addition, pain receptors have a memory of the pain, so they overreact to pain signals. There is no one cause of FM, but experts think it is related to genetics, illnesses that trigger symptoms, physical injury or trauma, or emotional trauma, such as post-traumatic stress disorder.  

About Failed Back Surgery Syndrome

In one study involving 1,450 patients diagnosed with disc herniation, radiculopathy, or disc degeneration, half of them had surgery involving fusion of vertebrae. The other half took medications and had physical therapy. After 2 years, 26% of those who had surgery reported that it actually worked. Other studies have shown that failed back surgery syndrome (FBSS) occurs in around 40-50% of people who have spine surgery. Experts estimate that around 600,000 U.S. citizens have back operations each year. A report by the Agency for Healthcare Research found that 27 million adults with back conditions spent over $30 billion on treatments for pain relief.

FBSS can occur after a laminectomy (removal of portion of vertebra), foraminotomy (removal of the foramina), discectomy (removal of disc or disc material), or spinal fusion. Causes of FBSS include issues unresolved before surgery, autoimmune disease, development of fibrotic or scar tissue, and excessive inflammation.

Study Design and Results

Dr. Caballero-Manrique, lead researcher, reported to the 2016 American Society of Regional Anesthesia and Pain Medicine regarding the study design and results. Studies have shown that fibromyalgia symptoms have less improvement following orthopedic procedures, such as hip replacement or knee surgery. In this study, researchers searched all patients who were treated at the University of Vermont Medical Center for the years 2010 through 2015. They found a significant association between FM and FBSS.

In addition, the study researchers noticed that the number of spine surgeries affected the prevalence of fibromyalgia as well. Around 50% of patients who had both conditions had undergone at least 4 back surgeries. For those individuals who did not have FM, the rate was only 30%. Researchers also observed a variety of surgeries. In the FM group, all patients had at least one lumbar (low-back), thoracic (mid-back), or cervical (neck) surgery.

The researchers and Caballero-Manrique hypothesized that patients with central sensitization had high numbers of surgery in order to alleviate symptoms. However, the nature of the pain was central and not peripheral, so the surgeries did not adequately treat their pain and associated symptoms. In fact, surgery may have worsened pain symptoms due to acute-phase nociceptors that produced decrease inhibitory neurons and increased pain signals.

Resources

National Fibromyalgia Association (2017). Prevalence. Retrieved from: http://www.fmaware.org/about-fibromyalgia/prevalence/

Nguyen TH, Randolphf DC, Talmage J, et al. (2011). Startling New Study Reveals That Back Surgery Fails 74% of the Time. SPINE, 36 (4): 320–331.