Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

PainSci » bibliography » Heffez et al 2007
updated Jul 24, 2020

Tags: treatment, counter-intuitive, etiology, neat, chronic pain, fibromyalgia, pro, pain problems

Two articles on PainSci cite Heffez 2007: 1. The Complete Guide to Chronic Tension Headaches 2. A Rational Guide to Fibromyalgia

PainSci notes on Heffez 2007:

This fascinating study follows from an early one (Heffez) that showed a clear link between fibromyalgia and myelopathy (the symptoms of cervical spinal cord compression). They tested the link more directly in this study by treating spinal cord compression surgically in 40 patients with the symptoms of both fibromyalgia, comparing the results to another 31 patients treated non-surgically. “There was a striking and statistically significant improvement” in the surgically treated patients, compared to the non-surgically treated patients.

The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients' quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking «does that mean a large effect size?» and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life. We recommend detailed neurological and neuroradiological evaluation of patients with fibromyalgia in order to exclude compressive cervical myelopathy, a potentially treatable condition.

related content

“Using Dynamic MRI to Diagnose Neck Pain: The Importance of Positional Cervical Cord Compression (PC3),” Andrew Holman, PracticalPainManagement.com.
“Positional cervical spinal cord compression and fibromyalgia: a novel comorbidity with important diagnostic and treatment implications,” Andrew J Holman, Journal of Pain, 2008.
“Fibromyalgia and Positional Cervical Cord Compression Differ Only By Autonomic Nervous System Consequences: A Double-Blinded, Prospective Study,” Andrew J Holman, Arthritis Rheumatol, 2015.
“Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia,” Dan S Heffez, Ruth E Ross, Yvonne Shade-Zeldow, Konstantinos Kostas, Sagar Shah, Robert Gottschalk, Dean A Elias, Alan Shepard, Sue E Leurgans, and Charity G Moore, European Spine Journal, 2004.
“Health update #3: My ME is in remission – Jennifer Brea – Medium,” Jennifer Brea, Medium.com.

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