Review Functional Somatic Syndromes Are Associated With Varied Postoperative Outcomes and Increased Opioid Use After Spine Surgery: 2023 Masood et al

Objective
To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and clinical outcomes after spine surgery.

Methods
A systematic review of online databases (PubMed and Web of Science) through December 2021 was conducted via PRISMA guidelines to identify all studies investigating the impact of at least one FSS (fibromyalgia, irritable bowel syndrome (IBS), chronic headaches/migraines, interstitial cystitis, chronic fatigue syndrome, multiple chemical sensitivity) on outcomes after spine surgery. Outcomes of interest included patient reported outcome measures (PROMs), postoperative opioid use, cost of care, complications, and readmission rates.

Results
A total of 207 records were identified. Seven studies (n = 40,011 patients) met inclusion criteria with a mean MINORS score of 16.6 out of 24. Four studies (n = 21,086) reported postoperative opioid use; fibromyalgia was a strong risk factor for long-term opioid use after surgery whereas the association with chronic migraines remains unclear. Two studies (n = 233) reported postoperative patient reported outcome measures (PROMs) with mixed results suggesting a possible association between fibromyalgia and less favorable PROMs. One study (n = 18,692) reported higher postoperative complications in patients with fibromyalgia.

Conclusion
Patients with fibromyalgia and possibly migraines are at higher risk for prolonged postoperative opioid use and less favorable PROMs after spine surgery. There is limited research on the relationship between other Functional somatic syndromes (FSSs) and outcomes following spine surgery. Growing evidence suggests the variation in outcomes after spine procedures may be attributed to non-identifiable organic patient factors such as FSSs.

Open access, https://journals.sagepub.com/doi/10.1177/21925682231217706

 

"The aim of this study was to perform a systematic review assessing the relationship between FSSs and outcomes after spine surgery. We looked at 6 diagnoses - fibromyalgia, irritable bowel syndrome, chronic headaches, interstitial cystitis, chronic fatigue syndrome, and multiple chemical sensitivity - that constitute FSSs. We hypothesized that the presence of at least one FSS is associated with worse patient reported outcome measures (PROMs) and greater opioid use after these procedures."

"The total number of subjects was 40,011. All 7 studies assessed fibromyalgia, 2 studies assessed migraines, and no studies assessed IBS, interstitial cystitis, chronic fatigue syndrome, or multiple chemical sensitivity. Determination of fibromyalgia was made using American College of Rheumatology (ACR) criteria (2) and medical records (5), whereas chronic migraine determination was made using medical records (2) only."

 

Spine surgery = no structural change (given definition of "functional"). People in pain use pain killers. People in pain tend to be diagnosed with a common diagnosis based on pain.

Groundbreaking stuff.