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Information for Surgeons

©Devin Starlanyl, MD 1995-1998

Patients with FMS and/or MPS may react differently to surgery and its associated care. Fibromyalgia is a pain amplification syndrome. Some of our receptor endings have changed, so we feel pain more intensely. We often have allodynia or hyperesthesia. Allodynia is a noxious response to a non-noxious stimuli, like feeling pain from light, cold, heat, touch, vibration or sound. Hyperesthesia is amplified sensation, especially pain. Be prepared for more intense post-surgical pain, as well as longer healing time due low growth hormone and associated healing factors. Immobility will usually cause symptoms to worsen, and muscles to contract. Sometimes patients will not be able to endure the hard hospital beds. Some of us even find water beds too hard, and need additional padding.

Patients with FMS&MPS Complex are more prone to adhesions, fibroids, cysts, overgrowths, and abnormal scarring. It is common for TrPs to form along incisions. This can be relieved by using Procaine to inject the surgical area immediately before surgery. Quotane, a topical prescription ointment, is helpful for TrP relief for close-to-the-surface areas not reachable by stretching. TrPs that refer burning, prickling or lightning-like jabs of pain are likely to be found in cutaneous scars.

During surgical repair, take extra care to approximate myofascia, and repair it whenever possible, keeping in mind that we do tend to form thickening of myofascial tissue in the form of ropy bands or lumps. This leads to contractured, shortened muscles, which lead to more TrPs.

People with FMS&MPS Complex often have atypical reactions to medications. The normal medication regimen for your patient may have to be "beefed up" during the recovery time. It is not unusual for FMS&MPS Complex symptoms to go into remission after general anesthesia. It may be the total relaxation of the muscles and subsequent removal of myofascial "splinting", and a change in the nature of ground substance. Clearly, research is needed in this phenomenon. As more physicians become clear on the difference between single muscle group TrPs, body-wide chronic MPS, FMS and the FMS&MPS Complex, patterns will become more clear.

There are several common "failed surgical procedures" due to pain from Trigger points. You should be familiar with these TrPs and their pain patterns. Trigger point pain is very specific. When TrPs occur, ask the patient about the body-wide achiness and sleep disruption of FMS, as well as the presence of other TrPs.

Low back pain: This is a tiger with many claws. The quadratus lumborum TrP is usually the main claw. It causes pain when walking, when turning in bed, when getting up from a chair, coughing or sneezing. It is often the cause of "failed surgical back syndrome. Patients get a deep "lightning bolt" pain from the quadratus lumborum to the front of the thigh. Pain may extend to the groin, testes, scrotum, or down the leg like sciatica. The quadratus lumborum TrP can cause a heaviness in the hips, a cramping of the calves, and burning sensations in the legs and feet. This can cause TrPs in those areas, which become other claws of the tiger.

Pain keeping your arms overhead: This is often due to subscapularis, infraspinatus, supraspinatus, upper trapezius, and levator scapulae TrPs. The subscapularis TrP not only causes the "toothache pain in the shoulder", but also refers pain at the wrists. It isn't unusual for me to see someone who has had failed carpal tunnel surgery on both wrists. In every case so far, treatment of the subscapularis and related TrPs has resulted in remission of wrist pain.

TRIGGER POINTS CANNOT BE REMOVED SURGICALLY. This may see self-evident, but I have seen patients who have seen doctors who tried. Sometimes, repeatedly. So much TrP preventative work can be in the hands of the surgeon. Once s/he is aware of the possible complications of FMS&MPS Complex, necessary surgical procedures should cause no undue trauma, and unneccesary ones should be avoided.

TrPs can mimic atypical facial neuralgia, arthritis, subdeltoid bursitis, collateral ligament damage, thoracic outlet syndrome, appendicitis, heel spurs, trochanteric bursitis and carpal tunnel syndrome. They can cause sciatica, contractures, back pain, and meralgia paresthetica. For more about this, contact the Gebauer Company in Ohio at 9419 St. Catherine Avenue, Cleveland, Ohio 44104, 800-321-9348, and ask for the monograph "Myofascial Pain Syndrome Due to Trigger Points" by David Simons M.D."

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