Story for “Anesthesiology News”,
SAN DIEGO, September 30, 2002

A superficial surgical procedure is providing a cure for intractable fibromyalgia of long duration, a German investigator reported here at the 2002 annual meeting of the International Association for the Study of Pain. The surgery is based on acupuncture points, where accumulated fibrous tissue is excised. “I know it sounds crazy, but it works,” Johann Bauer, MD, told Anesthesiology News.

Dr. Bauer reported that in the 10 years from 1990-2000, he has operated on 627 fibromyalgia patients of a total 1100 he has seen. Of those undergoing surgery 66% remain pain free, and 22% experienced an amelioration of their pain. Patients experiencing an improvement require a mean 20% of the medication dose they were taking prior to surgery. The patients who undergo surgery have established fibromyalgia with durations from 10-25 years. Dr. Bauer is Associate Professor of Surgery, Ludwig-Maximillians University, Munich, Germany.

The idea for the surgical treatment of fibromyalgia began when Dr. Bauer realized that the 18 tender points recommended by the American College of Rheumatology for diagnosis correspond to acupuncture points. He then recognized that fibromyalgia pain often follows acupuncture meridians. Next, he noticed fibrous clotting around specific sets of acupuncture points in the course of performing operations.

Dr. Bauer calls these acupuncture-point groupings where fibrous tissue accumulates “switchboxes of meridians.” The four important ones, where he operates, are on the inside of the ankles and on the back of the forearms. Via a single incision, 6-8 acupuncture points can be cleaned out at one of these switchboxes. The grouping on the forearm are about 1-inch below the skin, he noted, “almost on the radius bone.”

A cure for fibromyalgia would be a great boon, commented Hy Dubo, MD, in an interview with Anesthesiology News. Presently, there is no cure and symptoms can only be lessened. Most people with fibromyalgia continue to have chronic pain and fatigue. The use of acupuncture points to guide surgery is a novel concept, noted Dr. Dubo, who is Professor of Medicine, University of Manitoba, Canada.

David A. Cassius, MD, said the use of acupuncture meridians in fibromyalgia treatment is “very interesting.” The results that Dr. Bauer reported he called “fantastic. The fact that he is getting excellent results over time is a testament to the effectiveness,” he said in an interview.

Dr. Cassius said he uses needling for fibromyalgia treatment, but with 1% lidocaine and along dermatomal distributions. Segmental desensitization followed by needling of tender points can effect “tremendous pain relief” and allow patients to begin exercise therapy. “Exercise is the only [intervention] that has been shown to provide lasting relief in double-blind clinical trials,” noted Dr. Cassius, who is in private practice (physical medicine and rehabilitation) in Seattle, WA.

Dr. Bauer presented several examples of fibromyalgia patients whose pain resolved with surgery. One patient had whole-body severe pain of long duration. Dr. Bauer operated on her right forearm, and that quadrant became pain free over the course of several months. He then operated on the right ankle, and a similar improvement was seen in the right lower quadrant.

Pain in each quadrant is referred from acupuncture tender points and follows acupuncture meridians, Dr. Bauer suggested. A tender point for the large intestine meridian is on the base of thumb, for example, and pain can be referred up the arm and into the shoulder. The large intestine meridian then traverses up the neck, and the result can be maxilofacial pain. Or pain may cross-link at the shoulder to the gall-bladder meridian, and the result is headache, eye problems, and tinnitus.

“When you have headache, tinnitus, and facial pain, you must be operated on the forearm of the corresponding side. For back ache you must be operated here on the ankle,” he said. Dr. Cassius said that fibromyalgia pain that starts in one segment and then spreads globally “is something we see very commonly.” Fibromyalgia can be definitively diagnosed using acupressure, Dr. Bauer suggested. “It is no longer a wastebasket diagnosis.” Instead of using only 18 tender points, however, the physician may detect tenderness at any of the huge number of acupuncture points.

Acupuncture points are defined as an anatomical triad of artery, vein, and nerve, Dr. Bauer noted. He proposes that fibrous tissue accumulation is triggered by stress, either psychological or physical, which causes protein deposition by free nerve endings. Dr. Bauer believes that fibromyalgia begins in one body quadrant. It is often initially diagnosed as complex regional pain syndrome. Fibromyalgia then progresses and spreads to other quadrants, eventually encompassing the whole body. “The complete picture is displayed only in the course of a decade,” he said.

Surgery is necessary to clear out these acupuncture points in established disease, he continued. Early in the progression of fibromyalgia, acupuncture can be used to prevent spread. Acupuncture reduces inflammation, he said, but the fibrous tissue remains. Dr. Bauer said that the beginnings of fibromyalgia, confined to one quadrant, can be detected in young children.

Based on a presentation (Abstract 533-P167) at the 2002 annual meeting of the International Association for the Study of Pain, a web site www.FMS-Bauer.com and interviews with Johann Bauer, MD, Hy Dubo, MD, and David A. Cassius, MD.

Johann Bauer, MD

... more?

Associate Professor of Surgery
Ludwig-Maximillians University
Munich, Germany
eMail: office@FMS-Bauer.com

Hy Dubo, MD
Professor of Medicine
University of Manitoba, Canada
eMail: dubo@pangea.ca

David A. Cassius, MD
physical medicine and rehabilitation
Seattle, WA
eMail: DrCassius@onebox.com