Background: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to
spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they
have enhanced central nervous system sensitization and decreased descending inhibition.
Objective: The current study aims to verify the incidence and chronicity of PDPH in FMS
patients.
Study Design: Case control study.
Methods: In a comparative control study, 70 fibromyalgia patients were scheduled for
an elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 women
scheduled for elective cesarean delivery who had no history of chronic pain and is used as a
control group. Both groups were compared regarding the incidence of development of PDPH in
the 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 the
control group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patients
in the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPH
continued 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 may
use other analgesics due to musculoskeletal pain.
Conclusion: Dural puncture increases the incidence of PDPH in fibromyalgia patients in
comparison with normal controls without increasing other postoperative side effects.
Key Words: Fibromyalgia, cesarean section, post dural puncture headache, spinal anesthesia
Correlation between CCL2, CALCA, and CX3CL1 gene polymorphisms and chronic pain after cesarean section in Chinese Han women
