By Dr. Javier Rivera | May. 30, 2019 |Posts in English

People with fibromyalgia have more surgeries than other people. Studies with large databases of patients, and those that analyze health spending, show this alarming data. For example, 25% more knee prostheses are placed in patients with fibromyalgia and rheumatoid arthritis than in those with rheumatoid arthritis alone.

We have already analyzed the causes of this nonsense in previous articles: fibromyalgia is a disease with many symptoms (multi-symptomatic), in which multiple diagnoses are common (overdiagnosis) and, therefore, they also give several treatments (overtreatment); among others, surgical interventions.

Surgeries are done to solve a problem, but any surgery always carries a risk of complications arising from it. If the indication for surgery is clear, the risk can be assumed, but what about when it is not indicated…?

The first drawback of surgery is that it does not solve the problem. Shortly after having undergone an intervention, the patient finds to his great annoyance that his symptoms remain unchanged and this causes him great frustration. Perhaps this is the least problem, but the patient has already earned a useless surgical intervention.

Complications such as infections, metabolic alterations, delayed healing, loss of function or even worsening of the initial situation are not uncommon in any type of surgery, not to mention the stress that this entails for the patient or the significant economic impact for the health system.

Musculoskeletal surgeries are probably the most frequently performed in fibromyalgia, since the main symptom is generalized musculoskeletal pain. Recently –once again!–, the British health services have begun to question the usefulness of some common interventions, reaching conclusions that are worth knowing.

For example, in surgical interventions performed on the lumbar spine and those on the vertebral discs –both very common in people with fibromyalgia–, it has been possible to verify that the results are the same as in placebo interventions where nothing was done.

In arthroscopies and interventions on the knee menisci, the results are not different from those obtained in surgery where only an incision is made but the meniscus is not touched. In addition, two years after the intervention, there was also no difference between those who had the meniscus removed and those who did not

In relation to the numerous shoulder surgeries: subacromial decompression, rotator cuff pathology, labral surgery or biceps tenodesis, the results are not excessively favorable to the intervention either, which is why several surgeons have begun to reject these surgeries.

In other surgical interventions, such as the one done for carpal tunnel syndrome, a high percentage of unsatisfactory results have traditionally been seen. When the causes related to this failure are analyzed, the presence of chronic pain is one of the negatively associated factors. Something similar occurs with the failure of shoulder surgeries, where the presence of fibromyalgia is also a decisive factor.

In knee prostheses performed in patients with fibromyalgia, the risk of surgical complications of any kind is also increased compared to other people who do not suffer from the disease.

There are other frequent surgeries among people with fibromyalgia such as bariatric, thyroid, endometriosis, hysterectomy, pelvic floor or chronic cystitis, where we still have to wait for data to really assess its effectiveness.

I do not pretend that anyone reaches the conclusion that surgery should not be indicated in patients with fibromyalgia; regardless of the diagnosis of fibromyalgia, like any other person, you may have other associated problems that require surgical solutions and then they will have to be done.

But I want to warn that in people with fibromyalgia the probability that surgery will be useless or even cause more problems is increased compared to other patients. Therefore, in the event of a possible surgical intervention, both the patient and the surgeon must carefully assess these possibilities before making a decision.