Advertisement

Patients With Functional Somatic Syndromes—Fibromyalgia, Irritable Bowel Syndrome, Chronic Headaches, and Chronic Low Back Pain—Have Lower Outcomes and Higher Opioid Usage and Cost After Shoulder and Elbow Surgery

Published:December 30, 2022DOI:https://doi.org/10.1016/j.arthro.2022.12.028

      Purpose

      To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and patient-reported outcome measures (PROMs), postoperative opioid consumption, and hospitalization costs after shoulder and elbow surgery.

      Methods

      A systematic review of the PubMed and Web of Science databases was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies evaluating the effect of having at least 1 FSS (fibromyalgia, irritable bowel syndrome, chronic headaches, chronic low back pain) on outcomes after shoulder and elbow surgeries. Outcomes of interest included postoperative analgesic use, PROMs, and hospitalization costs.

      Results

      The review identified a total of 320 studies, of which 8 studies met the inclusion criteria. The total number of participants in our 8 included studies was 57,389. Three studies (n = 620) reported PROMs. These studies demonstrated that the presence of at least 1 FSS is predictive of significantly greater pain scores and lower quality of recovery, Disability Arm Shoulder and Hand, American Shoulder and Elbow Surgeons Shoulder Score, and Single Assessment Numeric Evaluation scores postoperatively. Although scores were inferior in among patients with FSS, 2 of the 3 studies showed improvement in PROMs in this group of patients. Seven studies (n = 56,909) reported postoperative opioid use. Of these, 5 reported that a diagnosis of at least 1 FSS was a strong risk factor for long-term opioid use after surgery. One study (n = 480) found that time-driven activity-based costs were significantly greater in patients with FSSs.

      Conclusions

      Patients with functional somatic syndromes have less-favorable PROMs postoperatively, consume more opioids postoperatively, and have greater health care costs after elective shoulder and elbow procedures. Although PROMs among patients with FSSs are inferior compared with those without FSSs, PROMs still improved compared with baseline.

      Level of Evidence

      Level III, systematic review of Level II-III studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Barsky A.J.
        Functional somatic syndromes.
        Ann Intern Med. 1999; 130: 910
        • Bourke J.H.
        • Langford R.M.
        • White P.D.
        The common link between functional somatic syndromes may be central sensitisation.
        J Psychosom Res. 2015; 78: 228-236
        • Wessely S.
        • Nimnuan C.
        • Sharpe M.
        Functional somatic syndromes: One or many?.
        Lancet. 1999; 354: 936-939
        • Graver C.J.
        Functional somatic syndrome: Assessment and management.
        J Osteopathic Med. 2017; 117: 511-519
        • De Sola H.
        • Dueñas M.
        • Salazar A.
        • Ortega-Jiménez P.
        • Failde I.
        Prevalence of therapeutic use of opioids in chronic non-cancer pain patients and associated factors: A systematic review and meta-analysis.
        Front Pharmacol. 2020; 11564412
        • Sicras A.
        • Rejas J.
        • Navarro R.
        • et al.
        Treating patients with fibromyalgia in primary care settings under routine medical practice: A claim database cost and burden of illness study.
        Arthritis Res Ther. 2009; 11: R54
        • Agarwal N.
        • Spiegel B.M.R.
        The effect of irritable bowel syndrome on health-related quality of life and health care expenditures.
        Gastroenterol Clin North Am. 2011; 40: 11-19
        • Ablin J.N.
        • Berman M.
        • Aloush V.
        • et al.
        Effect of fibromyalgia symptoms on outcome of spinal surgery.
        Pain Med. 2017; 18: 773-780
        • Donnally C.J.
        • Vakharia R.M.
        • Rush A.J.
        • et al.
        Fibromyalgia as a predictor of increased postoperative complications, readmission rates, and hospital costs in patients undergoing posterior lumbar spine fusion.
        Spine (Phila Pa 1976). 2019; 44: E233-E238
        • Straub T.A.
        Endoscopic carpal tunnel release: A prospective analysis of factors associated with unsatisfactory results.
        Arthroscopy. 1999; 15: 269-274
        • Komaroff A.L.
        • Fagioli L.R.
        • Doolittle T.H.
        • et al.
        Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups.
        Am J Med. 1996; 101: 281-290
        • Bedard N.A.
        • Pugely A.J.
        • Dowdle S.B.
        • Duchman K.R.
        • Glass N.A.
        • Callaghan J.J.
        Opioid use following total hip arthroplasty: Trends and risk factors for prolonged use.
        J Arthroplasty. 2017; 32: 3675-3679
        • Bedard N.A.
        • Pugely A.J.
        • Westermann R.W.
        • Duchman K.R.
        • Glass N.A.
        • Callaghan J.J.
        Opioid use after total knee arthroplasty: Trends and risk factors for prolonged use.
        J Arthroplasty. 2017; 32: 2390-2394
        • Boyle J.K.
        • Anthony I.C.
        • Jones B.G.
        • Wheelwright E.F.
        • Blyth M.J.G.
        Influence of low back pain on total knee arthroplasty outcome.
        Knee. 2014; 21: 410-414
        • Clement N.D.
        • MacDonald D.
        • Simpson A.H.R.W.
        • Burnett R.
        Total knee replacement in patients with concomitant back pain results in a worse functional outcome and a lower rate of satisfaction.
        Bone Joint J. 2013; 95-B: 1632-1639
        • Warren J.W.
        • Langenberg P.
        • Clauw D.J.
        The number of existing functional somatic syndromes (FSSs) is an important risk factor for new, different FSSs.
        J Psychosom Res. 2013; 74: 12-17
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Khazi Z.M.
        • Lu Y.
        • Shamrock A.G.
        • Duchman K.R.
        • Westermann R.W.
        • Wolf B.R.
        Opioid use following shoulder stabilization surgery: Risk factors for prolonged use.
        J Shoulder Elbow Surg. 2019; 28: 1928-1935
        • Khazi Z.M.
        • Lu Y.
        • Patel B.H.
        • Cancienne J.M.
        • Werner B.
        • Forsythe B.
        Risk factors for opioid use after total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2020; 29: 235-243
        • Moverman M.A.
        • Puzzitiello R.N.
        • Pagani N.R.
        • et al.
        Functional somatic syndromes are associated with suboptimal outcomes and high cost after shoulder arthroplasty.
        J Shoulder Elbow Surg. 2022; 31: 48-55
        • Rao A.G.
        • Chan P.H.
        • Prentice H.A.
        • et al.
        Risk factors for postoperative opioid use after elective shoulder arthroplasty.
        J Shoulder Elbow Surg. 2018; 27: 1960-1968
        • Rojas E.O.
        • Khazi Z.M.
        • Gulbrandsen T.R.
        • et al.
        Preoperative opioid prescription filling is a risk factor for prolonged opioid use after elbow arthroscopy.
        Arthroscopy. 2020; 36: 2106-2113
        • Lopiz Y.
        • Marcelo H.
        • Arvinius C.
        • Rodriguez-Rodriguez L.
        • García-Fernández C.
        • Marco F.
        Is fibromyalgia a cause of arthroscopic subacromial decompression failure?.
        Rev Esp Cir Ortop Traumatol (Engl Ed). 2019; 63: 275-280
        • Westermann R.W.
        • Anthony C.A.
        • Bedard N.
        • et al.
        Opioid consumption after rotator cuff repair.
        Arthroscopy. 2017; 33: 1467-1472
        • Cheng J.
        • Kahn R.L.
        • YaDeau J.T.
        • et al.
        The Fibromyalgia Survey Score correlates with preoperative pain phenotypes but does not predict pain outcomes after shoulder arthroscopy.
        Clin J Pain. 2016; 32: 689-694
        • Bernstein J.
        Not the last word: Fibromyalgia is real.
        Clin Orthop Relat Res. 2016; 474: 304-309
        • Brummett C.M.
        • Urquhart A.G.
        • Hassett A.L.
        • et al.
        Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty.
        Arthritis Rheumatol. 2015; 67: 1386-1394
        • Gierk B.
        • Kohlmann S.
        • Kroenke K.
        • et al.
        The somatic symptom scale-8 (SSS-8): A brief measure of somatic symptom burden.
        JAMA Intern Med. 2014; 174: 399-407
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        • et al.
        Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment.
        Arch Fam Med. 1994; 3: 774-779
        • Sheth D.S.
        • Ho N.
        • Pio J.R.
        • Zill P.
        • Tovar S.
        • Namba R.S.
        Prolonged opioid use after primary total knee and total hip arthroplasty: Prospective evaluation of risk factors and psychological profile for depression, pain catastrophizing, and aberrant drug-related behavior.
        J Arthroplasty. 2020; 35: 3535-3544
        • D’Onghia M.
        • Ciaffi J.
        • McVeigh J.G.
        • et al.
        Fibromyalgia syndrome—a risk factor for poor outcomes following orthopaedic surgery: A systematic review.
        Semin Arthritis Rheum. 2021; 51: 793-803
        • Compagnoni R.
        • Gualtierotti R.
        • Luceri F.
        • Sciancalepore F.
        • Randelli P.S.
        Fibromyalgia and shoulder surgery: A systematic review and a critical appraisal of the literature.
        J Clin Med. 2019; 8: E1518
        • Khazi Z.M.
        • Baron J.
        • Shamrock A.
        • et al.
        Preoperative opioid usage, male sex, and preexisting knee osteoarthritis impacts opioid refills after isolated arthroscopic meniscectomy: A population-based study.
        Arthroscopy. 2020; 36: 2478-2485
        • Anciano Granadillo V.
        • Cancienne J.M.
        • Gwathmey F.W.
        • Werner B.C.
        Perioperative opioid analgesics and hip arthroscopy: Trends, risk factors for prolonged use, and complications.
        Arthroscopy. 2018; 34: 2359-2367
        • Steiner S.R.H.
        • Cancienne J.M.
        • Werner B.C.
        Narcotics and knee arthroscopy: Trends in use and factors associated with prolonged use and postoperative complications.
        Arthroscopy. 2018; 34: 1931-1939
        • Ring D.
        • Sabharwal S.
        Opioids and orthopaedics in North America: Addressing a growing concern.
        J Bone Joint Surg. 2017; 99: 1881-1882
        • Longstreth G.F.
        Avoiding unnecessary surgery in irritable bowel syndrome.
        Gut. 2007; 56: 608-610
        • Pugely A.J.
        • Bedard N.A.
        • Kalakoti P.
        • et al.
        Opioid use following cervical spine surgery: Trends and factors associated with long-term use.
        Spine J. 2018; 18: 1974-1981
        • Qureshi R.
        • Werner B.
        • Puvanesarajah V.
        • et al.
        Factors affecting long-term postoperative narcotic use in discectomy patients.
        World Neurosurg. 2018; 112: e640-e644
        • Kalakoti P.
        • Hendrickson N.R.
        • Bedard N.A.
        • Pugely A.J.
        Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use.
        Spine (Phila Pa 1976). 2018; 43: 1208-1216
        • Skrejborg P.
        • Petersen K.K.
        • Kold S.
        • et al.
        Presurgical comorbidities as risk factors for chronic postsurgical pain following total knee replacement.
        Clin J Pain. 2019; 35: 577-582
        • Masuko K.
        • Nakamura H.
        Functional somatic syndrome: How it could be relevant to rheumatologists.
        Mod Rheumatol. 2007; 17: 179-184
      1. Freshman R, Oeding JF, Anigwe C, et al. Pre-existing mental health diagnoses are associated with higher rates of postoperative complications, readmissions, and reoperations following arthroscopic rotator cuff repair [published online August 23, 2022]. Arthroscopy. doi: 10.1016/j.arthro.2022.06.040.

        • Sochacki K.R.
        • Brown L.
        • Cenkus K.
        • Di Stasi S.
        • Harris J.D.
        • Ellis T.J.
        Preoperative depression is negatively associated with function and predicts poorer outcomes after hip arthroscopy for femoroacetabular impingement.
        Arthroscopy. 2018; 34: 2368-2374
        • Potter M.Q.
        • Sun G.S.
        • Fraser J.A.
        • et al.
        Psychological distress in hip arthroscopy patients affects postoperative pain control.
        Arthroscopy. 2014; 30: 195-201
        • Edwards R.R.
        • Bingham C.O.
        • Bathon J.
        • Haythornthwaite J.A.
        Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases.
        Arthritis Rheum. 2006; 55: 325-332
        • Price D.D.
        • Zhou Q.
        • Moshiree B.
        • Robinson M.E.
        • Verne G.N.
        Peripheral and central contributions to hyperalgesia in irritable bowel syndrome.
        J Pain. 2006; 7: 529-535
        • Bech N.H.
        • Sierevelt I.N.
        • de Rooij A.
        • Kerkhoffs G.M.M.J.
        • Haverkamp D.
        The influence of pain catastrophizing and central sensitization on the reported pain after hip arthroscopy.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 2837-2842
        • Clapp I.M.
        • Nwachukwu B.U.
        • Beck E.C.
        • et al.
        What is the role of kinesiophobia and pain catastrophizing in outcomes after hip arthroscopy for femoroacetabular impingement syndrome?.
        Arthrosc Sports Med Rehabil. 2020; 2: e97-e104
        • Henningsen P.
        • Zipfel S.
        • Sattel H.
        • Creed F.
        Management of functional somatic syndromes and bodily distress.
        Psychother Psychosom. 2018; 87: 12-31
        • Heijmans M.
        • Olde Hartman T.C.
        • van Weel-Baumgarten E.
        • Dowrick C.
        • Lucassen P.L.B.J.
        • van Weel C.
        Experts’ opinions on the management of medically unexplained symptoms in primary care. A qualitative analysis of narrative reviews and scientific editorials.
        Fam Pract. 2011; 28: 444-455