22 Apr Failed Back Surgery Syndrome is Associated with Fibromyalgia
Failed back surgery syndrome occurs in 40% of people who undergo spinal surgery. FBSS is a chronic, long-term condition. In a recent study, 87% of patients with FBSS had tried multiple medications, physical therapy, transcutaneous electrical nerve stimulation, interventional injections, and/or acupuncture. In addition, 78% of those with FBSS were on work disability. In a new study, researchers found that one of four patients with FBSS are also diagnosed with fibromyalgia.
Fibromyalgia occurs in 2% of the general population, but 25% of people with FBSS have fibromyalgia. Fibromyalgia is a protypical disease of centralized pain. According to surgeons and researchers, FBSS presents a tremendous burden on people, with direct costs of around $35,000 per patient. In addition, FBSS is associated with decreased quality of life, unemployment, and a high incidence of disability. When combined with fibromyalgia, FBSS can be a devastating disease.
Symptoms of FBSS and Fibromyalgia
The symptoms of fibromyalgia are slightly different than those of failed back surgery syndrome. With fibromyalgia, symptoms include:
- Widespread pain – Often described as a dull ache that persists for several months. In addition, the pain is widespread, occurring on both sides of the body, and below and above the waist.
- Cognitive difficulties – Called “fibro fog,” this cognitive clouding affects ability to pay attention, concentrate, and focus.
- Fatigue – Most all people with fibromyalgia complain of fatigue, which is not relieved by rest or sleeping. In addition, sleep disorders often occur, such as apnea and restless leg syndrome.
Failed back surgery syndrome usually does not cause psychological symptoms or fatigue. Rather, symptoms include pain of a sharp/stabbing quality, or a dull, aching of the neck, back, and/or legs. Most patients also have problems with mobility and radiating pain into the buttocks or legs.
Clinical Study of FBSS and Fibromyalgia
In a recent study, researchers found that there was a significant correlation between the number of surgeries someone had and a diagnosis of fibromyalgia. Around half of people diagnosed with both FBSS and fibromyalgia had undergone four back surgeries. In addition, for those patients with FBSS and no fibromyalgia, the surgery revision rate was only 30%. In one clinical study, researchers hypothesized that patients with central sensitization underwent a high number of procedures in order to alleviate their symptoms. However, because the problem was central, and not peripheral, surgery only worsened the pain.
The lead researcher, Dr. Caballero-Manrique, was encouraged by the results. She said that the scientists were motivated to do this study simply because the impact of failed back surgery can be quite devastating. The study was slightly limited by its retrospective nature, as well as the inability to identify patients with FBSS and fibromyalgia. Caballero-Manrique felt the study was a good start, but much more research was needed.
Functional Somatic Syndromes Study
Another study sought whether failed back surgery syndrome and fibromyalgia can be evaluated together as “functional somatic syndromes” (FSS). Researchers were interested in painful regions, fear of pain, pain intensity and frequency, age of onset, pain coping mechanisms, as well as duration of pain. Other areas of investigations included psychological characteristics, such as symptom interpretation, somatosensory amplification, and depression.
In the study, 150 patients were divided into 3 groups: the FSS group, the chronic medical illness group, and the control group. In the study, the FSS group did not differ as a function of the major clinical features and symptoms from other groups. The study confirmed that fibromyalgia and failed back surgery were very similar and could be evaluated under the single category of FSS.
DuRuk B, Ozlem H, Berk S, & Ketenc A (2015). Are fibromyalgia and failed back surgery syndromes actually “functional somatic syndromes” in terms of their symptomatological, familial and psychological characteristics? A comparative study with chronic medical illness and healthy controls. Agri 2015;27(3):123–131 doi: 10.5505/agri.2015.67044