title: Fibromyalgia survey criteria are associated with increased postoperative opioid consumption in women undergoing hysterectomy.
abstract: BACKGROUND
  The current study was designed to test the hypothesis that the fibromyalgia survey criteria would be directly associated with increased opioid consumption after hysterectomy even when accounting for other factors previously described as being predictive for acute postoperative pain.
  
  
  METHODS
  Two hundred eight adult patients undergoing hysterectomy between October 2011 and December 2013 were phenotyped preoperatively with the use of validated self-reported questionnaires including the 2011 fibromyalgia survey criteria, measures of pain severity and descriptors, psychological measures, preoperative opioid use, and health information. The primary outcome was the total postoperative opioid consumption converted to oral morphine equivalents.
  
  
  RESULTS
  Higher fibromyalgia survey scores were significantly associated with worse preoperative pain characteristics, including higher pain severity, more neuropathic pain, greater psychological distress, and more preoperative opioid use. In a multivariate linear regression model, the fibromyalgia survey score was independently associated with increased postoperative opioid consumption, with an increase of 7-mg oral morphine equivalents for every 1-point increase on the 31-point measure (Estimate, 7.0; Standard Error, 1.7; P < 0.0001). In addition to the fibromyalgia survey score, multivariate analysis showed that more severe medical comorbidity, catastrophizing, laparotomy surgical approach, and preoperative opioid use were also predictive of increased postoperative opioid consumption.
  
  
  CONCLUSIONS
  As was previously demonstrated in a total knee and hip arthroplasty cohort, this study demonstrated that increased fibromyalgia survey scores were predictive of postoperative opioid consumption in the posthysterectomy surgical population during their hospital stay. By demonstrating the generalizability in a second surgical cohort, these data suggest that patients with fibromyalgia-like characteristics may require a tailored perioperative analgesic regimen.
authors.affiliation: From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee (A.M.J.); Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan (S.A.-S.); Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan (B.R., S.E.M., D.J.C., C.M.B.); and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan (A.T.).
authors.forename: Allison M
authors.initials: AM
authors.lastname: Janda
authors.forename: Sawsan
authors.initials: S
authors.lastname: As-Sanie
authors.forename: Baskar
authors.initials: B
authors.lastname: Rajala
authors.forename: Alex
authors.initials: A
authors.lastname: Tsodikov
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Moser
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D058443:Catastrophization; D015331:Cohort Studies; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D009437:Neuralgia / Q000453:epidemiology / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D057566:Self Report; D013315:Stress, Psychological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid