Background & Aims

Fibromyalgia (FM) is a syndrome that affects 2 to 4% of the population, characterized by chronic widespread pain, fatigue, sleep disorders, and a variety of cognitive and somatic symptoms¹. This condition has a significant impact on patients’ quality of life, affecting both physical health and mental and emotional well-being. This case report focuses on a patient with FM, where a pharmacological approach with venous sympathetic block (VSB) was used for pain management.

Methods

The reported information was obtained through medical record review, patient interview, imaging exam record and literature review.

Results

A 54-year-old female patient with fibromyalgia presented with intense pain (VAS 8/10), anxiety, and insomnia. The initial diagnostic hypothesis was serotonin syndrome, due to symptoms and the use of SSRIs. Treatment for pain exacerbation included five sessions of VSB, with administration of various medications, resulting in decreased blood pressure and pain. The patient returned with moderate to mild pain and medium intensity headache. After medication optimization, including pregabalin, dipyrone, amitriptyline, losartan, and propranolol, and greater occipital nerve block, there was complete resolution of pain. After two months of follow-up, the patient reported significant pain improvement, disappearance of headache and neck pain, and started craft activities, swimming, and diet. The final DN4 assessment showed a decrease in neuropathic pain.

Conclusions

This case report demonstrates the effectiveness of venous sympathetic block with lidocaine, associated with adjuvants such as vitamin C, B complex, and magnesium sulfate, in the treatment of chronic pain resulting from fibromyalgia. The intervention resulted in a significant improvement in the patient’s quality of life, with substantial pain reduction and improvement in neuropathic pain assessment scores (DN4) and Visual Analog Scale (VAS). In addition, the patient was able to resume her daily life habits. This case suggests that venous sympathetic block may be a promising treatment strategy for chronic pain associated with fibromyalgia. However, more studies are needed to confirm these findings and further explore the potential of these interventions in the management of fibromyalgia.

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. DE SOUZA, Maiara Ferreira; KRAYCHETE, Durval Campos. A ação analgésica da lidocaína intravenosa no tratamento da dor crônica: uma revisão de literatura. revista brasileira de reumatología, v. 54, n. 5, p. 386-392, 2014.

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. SCHAFRANSKI, Marcelo Derbli et al. Intravenous lidocaine for fibromyalgia syndrome: an open trial. Clinical rheumatology, v. 28, p. 853-855, 2009.

5. 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.

6. 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.

7. STOMATOLOGY, Fourth Military; YAN, Qu. Effects of systemic magnesium on post-operative analgesia: is the current evidence strong enough. Pain Physician, v. 18, p. 405-417, 2015.

8. JÜRGENS, T. P. et al. Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain. The journal of headache and pain, v. 13, p. 199-213, 2012.

9. STRAUBE, Sebastian et al. Pregabalin in fibromyalgia: meta-analysis of efficacy and safety from company clinical trial reports. Rheumatology, v. 49, n. 4, p. 706-715, 2010.

10. FARAG, Hussein M. et al. Comparison of amitriptyline and us food and drug administration–approved treatments for fibromyalgia: A systematic review and network meta-analysis. JAMA Network Open, v. 5, n. 5, p. e2212939-e2212939, 2022.

11. GRASSI, Guido. Sympathetic activation and prognosis in cardiovascular disease. European Society of Cardiology, v. 5, n. 1, p. 11-28, 2006.

Presenting Author

Luisa Mesquita De Morais

Poster Authors

Victor Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Pedro Vinicius Araújo de Abreu

Student/trainee

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

Lead Author

Lukas Eiki Moriyama

Student/trainee

Universidade Federal da Grande Dourados

Lead Author

Matheus da Silva Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Lucio Gusmão Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Luisa Mesquita de Morais

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federa

Lead Author

Rafael Vieira Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federa

Lead Author

Gulliver Rezende Teodoro Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Fabio Koiti Nishimori

Centro Ortopédico de Taguatinga (COT) - Distrito Federal

Lead Author

Frederico Barra de Moraes

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Injections/Blocks