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

Arthroscopy. 2022 Dec 30;S0749-8063(22)00867-2.doi: 10.1016/j.arthro.2022.12.028. Online ahead of print.


Raisa Masood 1Krishna Mandalia 2Michael A Moverman 1Richard N Puzzitiello 1Nicholas R Pagani 1Mariano E Menendez 3Matthew J Salzler 4


Author information

1Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA.

2Tufts University School of Medicine, Boston, MA.

3Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.

4Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA. Electronic address: msalzler@tuftsmedicalcenter.org.


Purpose: To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and patient-reported outcome measures (PROMs), post-operative 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 PRISMA 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, patient reported outcome measures (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 one FSS is predictive of significantly higher pain scores and lower quality of recovery, DASH, ASES, and SANE scores postoperatively. Although scores were inferior in among patients with FSS, two of the three 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 one 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 higher in patients with FSSs.

Conclusions: Patients with functional somatic syndromes have less favorable PROMs postoperatively, consume more opioids postoperatively, and have higher healthcare costs after elective shoulder and elbow procedures. While PROMs among patients with FSSs are inferior compared to those without FSSs, PROMs still improve compared to baseline.

Level of evidence: Level III, systematic review of Level II-III studies.


© Copyright 2013-2024 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.