1. 2016;19;E871-E876Post Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study
   Observational Report
   Khalid M. Morsy, MBBCh, MSc, MD, Ayman M. Osman, MBBCh, MSc, MD, Omar M. Shaaban, MBBCh, MSc, MD, and Dina H. El-Hammady, MBBCh, MSc, MD.

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.