Effect of Fibromyalgia Symptoms on Outcome of Spinal Surgery

Ablin, Jacob N.; Berman, Mark; Aloush, Valerie; Regev, Gilad J.; Salame, Khalil; Buskila, Dan; Lidar, Zvi

doi:10.1093/pm/pnw232

Cited by 12 publications

(16 citation statements)

References 30 publications

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“…Calibration assessment showed that for patients with high baseline disability (>75 th percentile of ODI) the model tended to underestimate the proportion of worsening, and the prediction of worsening among those cases was too inaccurate. A reason could be the small sample size (type II error) of this subgroup, or confounding due to unmeasured factors, such as widespread body pain and pain interference [1]. Confounding is the most likely source of bias in our study.…”

Section: Discussionmentioning

confidence: 92%

“…Table 5 Failure and worsening 12 months after surgery for subgroups of different baseline disability (low, medium and high percentiles of the ODI score) in the training (n = 5741, 70%) and validation (n = 2218, 30%) set 1 Baseline ODI group based on the baseline percentile of the ODI score -low (<25 th percentile, <33 points), medium (25 th -75 th percentile, 33-58 points), high (>75 th percentile, >58 points). ODI range: 0-100 (no-maximal disability)…”

Section: Discussionmentioning

confidence: 99%

“…Duration of preoperative back pain was highly correlated (CC >0.7) with duration of preoperative leg pain. Duration of preoperative leg pain was consequently excluded from the model because Table 1 Baseline characteristics including patient-reported outcome measures of respondents vs. non-respondents (lost to follow-up) 1 Less than 4 years of college/university education. 2 Rheumatoid arthritis, ankylosing spondylitis, other rheumatic disorder, hip arthrosis, knee arthrosis, chronic generalized musculoskeletal pain, chronic neurologic disorder, cerebrovascular disorder, heart disease, vascular disease, chronic lung disease, cancer, osteoporosis, hypertension, diabetes mellitus, other endocrine disorder.…”

Section: Prognostic Factors and Outcomesmentioning

confidence: 99%

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A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

et al. 2021

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Objective To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. Methods This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. Results The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. Conclusion We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Prognostic Factors and Outcomesmentioning

confidence: 99%

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A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

et al. 2021

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“…In patients undergoing spinal surgery, FMS is both highly prevalent (22.5% of patients), and associated with less reduction in pain post-surgery compared to FMS negative patients (14). This study grouped patients based on whether they fulfilled the ACR 2010 diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

Should a Coexisting or Suspected Diagnosis of Fibromyalgia Affect the Decision to Perform Diagnostic Blocks for Patients with Chronic Noncancer Pain — Results from an Observational Research Study

2021

Pain Phys

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BACKGROUND: Diagnostic injections (blocks) are a valuable tool in the management of chronic noncancer pain. By precise blockade of specific neural structures and observation of pain responses, pain mechanisms can be accurately defined. With such information, therapeutic procedures targeting neural structures are possible. Fibromyalgia is a disorder of pain processing with characteristic symptoms. The 2010 American College of Rheumatologists fibromyalgia diagnostic criteria evaluates these symptoms in a scoring system, allowing more objectivity in the diagnosis. We hypothesize that patients with fibromyalgia phenotype fulfilling the 2010 American College of Rheumatologists criteria may respond to diagnostic blocks differently when compared to patients without fibromyalgia phenotype. OBJECTIVES: This study was designed to establish whether diagnosis or suspected diagnosis of fibromyalgia should influence the decision to perform diagnostic blocks for chronic non-cancer pain. STUDY DESIGN: A prospective observational research study was performed at our institution. IRAS project ID: 231514. SETTING: Tertiary pain clinic in the UK. METHODS: Patients were selected to receive diagnostic block by usual clinical assessment after which they were asked to consent to take part in the study. All participating patients completed the 2010 American College of Rheumatologists fibromyalgia diagnostic questionnaire prior to the diagnostic block. Patients were divided into 2 groups A and B based on the outcome of block — primary outcome. Group A experienced a 70% or greater improvement in pain severity following the block for the anticipated duration of action of the local anesthetic, Group B experienced a less than 70% reduction in pain. Statistical analysis between groups A and B was conducted by comparing categorical data, described as percentages, with the 2 test. Ordinal variables such as Widespread pain index and Symptom severity score are presented as median and analyzed with Mann-Whitney test. RESULTS: Seventy-seven patients were included in the study. Two patients were lost to follow-up. Of the 75 remaining patients, 44 received lumbar medial branch blocks, 19 genicular nerve blocks, 3 blocks to nerves supplying the sacroiliac joint, one suprascapular nerve block, and 6 cervical and 2 thoracic medial branch blocks. Group A contained 38 patients and group B contained 37 patients. There was no statistically significant difference in the prevalence of fibromyalgia screening questionnaire positive patients between groups A (13 out of 38 patients) and B (13 out of 37 patients), P = 0.93. There was no statistically significant difference in the prevalence of fibromyalgia screening questionnaire positive patients in subgroups undergoing the same type of diagnostic block (spinal pain and knee pain). LIMITATIONS: Selection of patients prior to inclusion in the study may introduce bias. Patients were selected by individual treating clinicians using usual clinical practice; however, the exact selection criteria were not standardized. CONCLUSION: We conclude that after physician selection, the presence of fibromyalgia phenotype does not influence the outcome from diagnostic block. It is likely therefore that fibromyalgia phenotype should not influence the decision to perform diagnostic blocks if indicated based on assessment by an experienced pain physician. KEY WORDS: Fibromyalgia, chronic pain, diagnostic blocks, fibromyalgia diagnostic criteria, interventional pain management, chronic noncancer pain, medial branch block, genicular block, central sensitization

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“…51,135 In particular, in the context of pain after surgical insult, the presence of comorbid fibromyalgia, or even symptomatic features of fibromyalgia, is highly associated with the persistence of postoperative pain complaints and analgesic usage after surgery. 5,41 In addition, the degree of fibromyalgia symptomatology is specifically related to the magnitude of neuropathic pain symptoms in surgical patients. 47 Several studies have noted that persisting postoperative pain in the surgical body region is associated with widespread bodily pain complaints and with amplified sensitivity to painful stimuli, which may reflect central sensitization-related mechanisms that contribute even to peripheral neuropathic symptomatology.…”

Section: Dimension 3: Common Medical and Psychiatric Comorbiditiesmentioning

confidence: 99%

AAPT Diagnostic Criteria for Peripheral Neuropathic Pain: Focal and Segmental Disorders

Freeman

Edwards

Baron

et al. 2019

The Journal of Pain

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Effect of Fibromyalgia Symptoms on Outcome of Spinal Surgery

Cited by 12 publications

References 30 publications

A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

Should a Coexisting or Suspected Diagnosis of Fibromyalgia Affect the Decision to Perform Diagnostic Blocks for Patients with Chronic Noncancer Pain — Results from an Observational Research Study

AAPT Diagnostic Criteria for Peripheral Neuropathic Pain: Focal and Segmental Disorders

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