title: Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization.
abstract: Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1week, 1,3,6 and 12months after laparoscopic cholecystectomy in fibromyalgia patients with symptomatic calculosis (n = 31) vs calculosis patients without fibromyalgia (n. 26) and at comparable time points in fibromyalgia patients not undergoing cholecystectomy, with symptomatic (n = 27) and asymptomatic (n = 28) calculosis, and no calculosis (n = 30). At basis, fibromyalgia+symptomatic calculosis patients presented a significant linear correlation between the number of previously experienced biliary colics and fibromyalgia pain (direct) and muscle thresholds (inverse)(p<0.0001). After cholecystectomy, fibromyalgia pain significantly increased and all thresholds significantly decreased at 1week and 1month (1-way ANOVA, p<0.01-p<0.001), the decrease in muscle thresholds correlating linearly with the peak postoperative pain at surgery site (p<0.003-p<0.0001). Fibromyalgia pain and thresholds returned to preoperative values at 3months, then pain significantly decreased and thresholds significantly increased at 6 and 12months (p<0.05-p<0.0001). Over the same 12-month period: in non-fibromyalgia patients undergoing cholecystectomy thresholds did not change; in all other fibromyalgia groups not undergoing cholecystectomy fibromyalgia pain and thresholds remained stable, except in fibromyalgia+symptomatic calculosis at 12months when pain significantly increased and muscle thresholds significantly decreased (p<0.05-p<0.0001). The results of the study show that biliary colics from gallbladder calculosis represent an exacerbating factor for fibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of their treatment on fibromyalgia pain/hypersensitivity.
authors.affiliation: Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Costantini
authors.affiliation: Fibromyalgia and Musculoskeletal Pain Center, Department of Medicine and Science of Aging and Ce.S.I., "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Giannapia
authors.initials: G
authors.lastname: Affaitati
authors.affiliation: Institute of Clinical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Massimini
authors.affiliation: Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tana
authors.affiliation: Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Innocenti
authors.affiliation: Fibromyalgia and Musculoskeletal Pain Center, Department of Medicine and Science of Aging and Ce.S.I., "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Maria Adele
authors.initials: MA
authors.lastname: Giamberardino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D004558:Electric Stimulation; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D005705:Gallbladder Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006930:Hyperalgesia / Q000150:complications*; D020347:Lithiasis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000150:complications*; D017288:Pain Threshold; D010149:Postoperative Pain / Q000209:etiology; D011312:Pressure; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult