Open AccessPost Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study
Author(s) -
Khalid M. Morsy MBBCh
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2016.19.e871
Subject(s) - medicine , fibromyalgia , incidence (geometry) , anesthesia , post dural puncture headache , cohort , physical therapy , surgery , spinal anesthesia , physics , optics
Background: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected tospinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as theyhave enhanced central nervous system sensitization and decreased descending inhibition.Objective: The current study aims to verify the incidence and chronicity of PDPH in FMSpatients.Study Design: Case control study.Methods: In a comparative control study, 70 fibromyalgia patients were scheduled foran elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 womenscheduled for elective cesarean delivery who had no history of chronic pain and is used as acontrol group. Both groups were compared regarding the incidence of development of PDPH inthe first postoperative 48 hours and the persistence of PDPH for 7 days or more.Settings: Women’s Health Hospital, Assiut University, antenatal Clinic.Results: The fibromyalgia group reported more PDPH (18 patients, 25.7%) as compared to thecontrol group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patientsin the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPHcontinued for more than 3 months in 2 patients in the fibromyalgia group (2.86%)Limitations: Difficulty in calculating the dose of analgesics as patients with fibromyalgia mayuse other analgesics due to musculoskeletal pain.Conclusion: Dural puncture increases the incidence of PDPH in fibromyalgia patients incomparison with normal controls without increasing other postoperative side effects.Key Words: Fibromyalgia, cesarean section, post dural puncture headache, spinal anesthesia