title: Survey criteria for fibromyalgia independently predict increased postoperative opioid consumption after lower-extremity joint arthroplasty: a prospective, observational cohort study.
abstract: BACKGROUND
  Variance in pain after total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, the authors conducted a prospective, observational cohort study of patients undergoing lower-extremity joint arthroplasty.
  
  
  METHODS
  Five hundred nineteen patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to being assessed for factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being "present" or "absent," features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption.
  
  
  RESULTS
  Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption.
  
  
  CONCLUSIONS
  The use of the survey criteria for fibromyalgia led to the finding of distinct phenotypic differences, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population.
authors.affiliation: * Assistant Professor, ‖ Associate Research Scientist, # Professor, Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan. † Medical Student, University of Michigan Medical School, Ann Arbor, Michigan. ‡ Medical Student, Wayne State University School of Medicine, Detroit, Michigan. § Professor, Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
authors.forename: Allison M
authors.initials: AM
authors.lastname: Janda
authors.forename: Christa M
authors.initials: CM
authors.lastname: Schueller
authors.forename: Alex
authors.initials: A
authors.lastname: Tsodikov
authors.forename: Michelle
authors.initials: M
authors.lastname: Morris
authors.forename: David A
authors.initials: DA
authors.lastname: Williams
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
mesh_terms: D059787:Acute Pain / Q000188:drug therapy; D000328:Adult; D000339:Affect; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D001007:Anxiety / Q000150:complications; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D058443:Catastrophization; D003863:Depression / Q000150:complications; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy / Q000523:psychology; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D018579:Patient Selection; D010641:Phenotype; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D000701:Analgesics, Opioid