Fibromyalgia patients undergo unnecessary operations

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Rheumawire

May 4, 2004

Fibromyalgia patients undergo unnecessary operations

Edinburgh, Scotland - UK rheumatologists reviewing case notes for

fibromyalgia patients found that half of them had undergone surgery

under general anesthesia, even when macroscopic and microscopic findings

were normal. One patient had undergone 12 operations with normal

findings and suffered iatrogenic harm, the doctors told the recent

meeting of the British Rheumatology Society. " Our management of this

group of patients needs to be improved, " they commented [1].

The review involved 20 patients who were attending a consultant nurse

specialist clinic in the rheumatology department of the North

Staffordshire Royal Infirmary. All of them fulfilled the American

College of Rheumatology criteria for fibromyalgia.

All of the patients had previously seen other medical specialists (mean

7.1, range 4-14). They had undergone an average of 5 operations (range

0-37) under general anesthesia, the meeting heard. Half of the patients

(10/20) underwent surgery with normal macroscopic and microscopic

findings, and most had normal findings on surgery, with average normal

findings at surgery of 2.8 (range 1-12)

" These patients had been to see gynecologists with dysmenorrhea,

neurologists with headache and fatigue, gastroenterologists with

irritable bowel syndrome and abdominal pain, and orthopedic surgeons

with pains in specific joints, " Dr Dawes (North Staffordshire

Royal infirmary) tells rheumawire. They also had a " whole host of

various surgeries, " he says, including arthroscopies, endoscopies,

appendectomy when the appendix that was removed was fine, bladder

suspensions for urinary retention, laparotomies for seeking causes of

pain, spinal surgery for back pain, and others.

The patient who underwent 12 operations with normal findings had 2

incidents where the surgery caused damage: her bladder ruptured during a

cystodistention, and an excision of an anal tag resulted in a functional

fissure that required a further operation.

These often-expensive procedures are usually unnecessary and of no

benefit to the patient, so not only they are wasting time and money,

they may actually harm the patient, Dawes points out, and should be

avoided.

One of the problems, Dawes suggests, is that a lot of specialists work

within their own environment and don't take a more general look at these

patients. He says all clinicians should look beyond their specialty and

try to recognize features of a more generalized pain

disorder " fibromyalgia, chronic pain syndrome, somatoform disorders,

whatever you like to call it. I don't think there is a lot of

understanding about these syndromes. "

" Our perspective is that these patients should be managed within the

community, but they should be highlighted with a red-flag type system, "

Dawes continues. " Of course, a patient with chronic pain can get

appendicitis like anyone else, but what you shouldn't be doing is

necessarily subjecting patients like this with a grumbling appendix or

abdominal pain to surgery, unless there are other pointers, because that

only seems to aggravate the symptomatology . . . it seems to compound

the way they look at themselves and how they feel about their problems. "

Zosia Chustecka

Source

1. Kinder AJ, Dawes PT, Clement D et al. Do patients with fibromyalgia

undergo unnecessary operations? Rheumatology 2004; 43(supplement

2):ii72.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org