High-Frequency Accessory and Transcapular Nerve Blocks in the Management of Fibromyalgia: A Case Report.

This is the first case report describing the effect of weekly accessory nerve and transcapular nerve blocks for managing fibromyalgia (FM)-related pain in a 45-year-old female patient. The diagnosis was established using the new American College of Rheumatologist criteria. Following diagnosis, bilateral accessory and transcapular nerve blocks were administered using Xylocaine. In this particular patient, the nerve blocks decreased the numeric rating scale from 9 to 2 after treatment in the same visit, improved the benefits of daily activities, and improved tolerance of physical activities in six months. The patient reported significant improvement in pain, supporting the hypothesis that interventional management, like nerve blocks, may reduce peripheral nociceptive input and mitigate central sensitization, a hallmark of FM. The findings of this case report suggest that targeted nerve blocks can serve as a complementary treatment for FM-related neck and shoulder pain, particularly in cases involving myofascial trigger points in the trapezius and infraspinatus muscles. By integrating accessory and transcapular nerve blocks with existing multidisciplinary management approaches, clinicians can offer more options for pain management for FM patients with neck and shoulder pain. However, future randomized controlled trials are essential for cause-effect relationships and optimizing nerve block treatment protocols to support evidence-based practices and better patient outcomes.