Aberrant Analgesic Response to Medial Branch Blocks in Patients With Characteristics of Fibromyalgia. Issue 3 (May 2015)

• Record Type: Journal Article
• Authors: Brummett, Chad M.; Lohse, Andrew G.; Tsodikov, Alex; Moser, Stephanie E.; Meraj, Taha S.; Goesling, Jenna; Hooten, Michael; Hassett, Afton L.
• Is Part Of: Regional anesthesia and pain medicine. Volume 40:Issue 3(2015)
• Publication Date: 2015-05
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1097/AAP.0000000000000235
• Languages: English
• ISSNs: 1098-7339

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background and Objectives</title> <p>Facet interventions for spine pain have high failure rates, and preprocedural prediction of response is nearly impossible. A potential explanation may be aberrant central pain processing as that existing in conditions like fibromyalgia. To test this hypothesis, we conducted a retrospective study investigating the impact of having characteristics of fibromyalgia on the acute analgesic response to a first diagnostic medial branch block (MBB).</p> </sec> <sec> <title>Methods</title> <p>We evaluated the analgesic responses of 187 patients that underwent MBB. Patients were categorized as "fibromyalgia-positive" or "fibromyalgia-negative" using the 2011 fibromyalgia survey criteria. Preprocedural and postprocedural pain scores and patient-completed pain diaries up to 24 hours postprocedure were collected. A linear mixed model was used to study longitudinal effects of MBB on pain responses.</p> </sec> <sec> <title>Results</title> <p>Fibromyalgia-positive patients had a worse preprocedural pain phenotype (ie, greater pain severity, higher levels of depressive and anxiety symptoms, reduced function). Binary categorization of fibromyalgia status was not associated with a difference in immediate postprocedural pain relief; however, the longitudinal analgesic response across time varied significantly between groups (<italic>P</italic> = 0.0005). Fibromyalgia-negative subjects showed the expected steep decline in pain scores, followed by gradual return to baseline, whereas a more aberrant pattern was noted in the fibromyalgia-positive group. Pain scores for fibromyalgia-negative patients were also lower by −1.07 (SE = 0.37) on average after the MBB (<italic>P</italic> = 0.005).</p> </sec> <sec> <title>Conclusions</title> <p>Characteristics of fibromyalgia may indicate pain that is more centralized in nature, a factor that may explain the aberrant analgesic response to this peripheral intervention. This may have implications for future prediction of treatment response, although prospective studies are needed.</p> </sec> </abstract>