Background & Aims

Fibromyalgia (FM) is a condition that affects 2 to 4% of the population, manifesting as widespread chronic pain, fatigue, sleep disorders, and a range of cognitive and somatic symptoms. This syndrome has a significant impact on the quality of life of affected individuals, compromising both physical health and mental and emotional balance. This case study focuses on a patient with FM, in which venous sympathetic blockade (VSB) was employed as a pharmacological strategy for pain control in the brazilian public health system.

Methods

The information presented was meticulously compiled through a comprehensive review of medical records, direct patient interviews, analysis of imaging test results, and an extensive review of the relevant literature.

Results

A 55-year-old patient with fibromyalgia, type 2 diabetes, hypertension, and grade III obesity presented with intense pain and a Visual Analogue Scale (VAS) score of 8/10 in the left shoulder and cervical region, radiating to the left occipitotemporal region. Despite being on a polypharmacy regimen, the pain persisted. The patient underwent a venous sympathetic blockade (VSB), which included the administration of various medications. After two hours of infusion, in the first session, the pain significantly decreased. During treatment, minimal hospital resources were used. The patient showed significant improvement, but the medical team anticipates the need for additional infiltrations in the future for ongoing pain management.

Conclusions

This case study highlights the use of venous sympathetic blockade with lidocaine and adjuvants as an effective and economical strategy to treat intensified pain in patients with fibromyalgia, avoiding the risks of dependence associated with prolonged use of opioids. The intervention resulted in a significant improvement in the patient’s quality of life, evidenced by a marked reduction in pain and a notable decrease in the scores of the neuropathic pain assessment (DN4) and the Visual Analogue Scale (VAS). It presents an affordable treatment strategy that can be widely implemented even in resource-limited settings and by reducing dependency on opioids, it can potentially decrease the healthcare costs associated with managing opioid addiction and its complications.

References

1. COHEN-BITON, Liraz; BUSKILA, Dan; NISSANHOLTZ-GANNOT, Rachel. Review of fibromyalgia (FM) syndrome treatments. International Journal of Environmental Research and Public Health, v. 19, n. 19, p. 12106, 2022.

2. NASCIMENTO, Daiana Ciléa Honorato; SAKATA, Rioko Kimiko. Dependência de opioide em pacientes com dor crônica. Revista dor, v. 12, p. 160-165, 2011.

3. OLIVEIRA, Caio Marcio Barros de; ISSY, Adriana Machado; SAKATA, Rioko Kimiko. Lidocaína por via venosa intraoperatória. Revista Brasileira de Anestesiologia, v. 60, p. 325-332, 2010.

4. MASIC, Dalila et al. Intravenous lidocaine for acute pain: a systematic review. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, v. 38, n. 12, p. 1250-1259, 2018.

5. E SILVA, Lucas Oliveira J. et al. Safety and efficacy of intravenous lidocaine for pain management in the emergency department: a systematic review. Annals of emergency medicine, v. 72, n. 2, p. 135-144. e3, 2018.

6. LOVETT-CARTER, Danielle et al. The effect of systemic lidocaine on post-operative opioid consumption in ambulatory surgical patients: a meta-analysis of randomized controlled trials. Perioperative Medicine, v. 10, p. 1-12, 2021.

7. DE OLIVEIRA, Kyle; EIPE, Naveen. Intravenous lidocaine for acute pain: a single-institution retrospective study. Drugs-real world outcomes, v. 7, p. 205-212, 2020.

8. CARR, Anitra C.; MCCALL, Cate. The role of vitamin C in the treatment of pain: new insights. Journal of translational medicine, v. 15, p. 1-14, 2017.

9. GAZONI, Fernanda Martins; MALEZAN, William Rafael; SANTOS, Fânia Cristina. O uso de vitaminas do complexo B em terapêutica analgésica. Revista Dor, v. 17, p. 52-56, 2016.

Presenting Author

Luisa Mesquita De Morais

Poster Authors

Victor Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Pedro Vinicius Araújo de Abreu

Student/trainee

Escola Superior de Ciências da Saúde (ESCS) - Distrito Federal

Lead Author

E-mail

Juliano Januário de Araújo

Student/trainee

Universidade de Gurupi – UNIRG

Lead Author

E-mail

Matheus da Silva Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Lucio Gusmão Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Luisa Mesquita de Morais

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Rafael Vieira Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Gulliver Rezende Teodoro Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Frederico Barra de Moraes

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Fabio Koiti Nishimori

Centro Ortopédico de Taguatinga (COT) - Distrito Federal

Lead Author

E-mail

Topics

  • Treatment/Management: Interventional Therapies – Injections/Blocks