{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T14:03:56Z","timestamp":1781100236917,"version":"3.54.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mexican Secretariat of Science, Humanities, Technology and Innovation"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Fibromyalgia is a complex, heterogeneous and often disabling syndrome that seriously affects the quality of life of patients. It is characterized by chronic widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairment. Its pathophysiology remains poorly understood, and conventional treatments often offer limited efficacy while carrying significant side effects, highlighting the urgent need for alternative therapeutics strategies. We report a retrospective case series evaluating a novel protocol that combines low frequency Pulsed Electromagnetic Field (PEMF) therapy, medical ozone insufflation, and targeted nutritional supplementation in three patients with refractory fibromyalgia who had previously shown inadequate response to conventional treatments. Following the intervention, patients experienced substantial pain relief and significant improvement in quality of life, which were sustained at the 30-day follow-up assessment. These findings suggest that the combination of PEMF and ozone therapy may induce durable physiological benefits, presenting a promising complementary strategy for managing refractory fibromyalgia.<\/jats:p>","DOI":"10.3389\/fmed.2026.1763506","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:43:08Z","timestamp":1776228188000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Integrative management of refractory fibromyalgia with pulsed electromagnetic fields and ozone therapy: a case series"],"prefix":"10.3389","volume":"13","author":[{"given":"Jes\u00fas Antonio","family":"Lara-Reyes","sequence":"first","affiliation":[{"name":"Instituto de Investigaciones Cerebrales, Universidad Veracruzana","place":["Xalapa, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo Emiliano","family":"Aranda-Abreu","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cerebrales, Universidad Veracruzana","place":["Xalapa, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xamanek","family":"Cortijo-Palacios","sequence":"additional","affiliation":[{"name":"Centro de EcoAlfabetizaci\u00f3n y Dialogo de Saberes, Universidad Veracruzana","place":["Xalapa, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoldo","family":"Aquino-G\u00e1lvez","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Enfermedades Respiratorias","place":["Ciudad de M\u00e9xico, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Castillejos-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Enfermedades Respiratorias","place":["Ciudad de M\u00e9xico, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick Gerardo","family":"Ruiz-Moya","sequence":"additional","affiliation":[{"name":"Centro m\u00e1s Longevidad","place":["Xalapa, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Rojas-Dur\u00e1n","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cerebrales, Universidad Veracruzana","place":["Xalapa, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fmed.2018.00094","article-title":"Fibromyalgia syndrome: a case report on controlled remission of symptoms by a dietary strategy","volume":"5","author":"Lattanzio","year":"2018","journal-title":"Front Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"381","DOI":"10.47197\/retos.v53.102789","article-title":"Psychometric properties of the fibromyalgia impact questionnaire in Mexican women","volume":"2041","author":"Gurrola","year":"2024","journal-title":"Retos"},{"key":"ref3","first-page":"185","article-title":"Fibromialgia. Visi\u00f3n cl\u00ednica","volume-title":"Semin M\u00e9d","author":"Colodro","year":"2021"},{"key":"ref4","first-page":"1","article-title":"Recomendaciones para el uso racional del medicamento en el tratamiento farmacol\u00f3gico de las enfermedades reum\u00e1ticas y musculoesquel\u00e9ticas","author":"P\u00e9rez Venegas","year":"2022","journal-title":"Osteoporos"},{"key":"ref5","first-page":"1","volume-title":"Management of Fibromyalgia: An Update","author":"Jones","year":"2024"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2174\/18743129-v16-e2209290","article-title":"Fibromyalgia concomitant with seropositive rheumatoid arthritis in a tertiary hospital in South-Western Saudi Arabia: prevalence and treatment patterns","volume":"16","author":"AlOmair","year":"2022","journal-title":"Open Rheumatol J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e10856","DOI":"10.25248\/reas.e10856.2022","article-title":"Preval\u00eancia da dor e percep\u00e7\u00e3o do tratamento em pacientes com fibromialgia","volume":"15","author":"de Ara\u00fajo","year":"2022","journal-title":"Rev Eletr\u00f4nica Acervo Sa\u00fade"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0284168","DOI":"10.1371\/journal.pone.0284168","article-title":"Amitriptyline\u2019s anticholinergic adverse drug reactions\u2013a systematic multiple-indication review and meta-analysis","volume":"18","author":"Brueckle","year":"2023","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e02111334850","DOI":"10.33448\/rsd-v11i13.34850","article-title":"O uso de antidepressivos tric\u00edclicos no tratamento da fibromialgia: uma revis\u00e3o bibliogr\u00e1fica","volume":"11","author":"da Silva","year":"2022","journal-title":"Res Soc Dev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e2212939","DOI":"10.1001\/jamanetworkopen.2022.12939","article-title":"Comparison of amitriptyline and US Food and Drug Administration\u2013approved treatments for fibromyalgia","volume":"5","author":"Farag","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"77","DOI":"10.2478\/rir-2022-0013","article-title":"Low-energy pulsed electromagnetic field therapy reduces pain in fibromyalgia: a randomized single-blind controlled pilot study","volume":"3","author":"Giovale","year":"2022","journal-title":"Rheumatol Immunol Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1097\/AJP.0b013e3181a68a6c","article-title":"Low-frequency pulsed electromagnetic field therapy in fibromyalgia: a randomized, double-blind, sham-controlled clinical study","volume":"25","author":"Sutbeyaz","year":"2009","journal-title":"Clin J Pain"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"43","DOI":"10.4081\/ozone.2018.7969","article-title":"Ozone therapy in 40 patients with fibromyalgia: an effective therapy","volume":"3","author":"Tirelli","year":"2018","journal-title":"Ozone Ther"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s00296-025-05827-1","article-title":"Short- and medium-term effects of major ozone therapy on disease parameters in fibromyalgia syndrome: a retrospective study","volume":"45","author":"\u00dc\u015fen","year":"2025","journal-title":"Rheumatol Int"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1186\/s40001-024-01976-4","article-title":"Ozone therapy in musculoskeletal medicine: a comprehensive review","volume":"29","author":"Jeyaraman","year":"2024","journal-title":"Eur J Med Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.26355\/eurrev_201902_17141","article-title":"Ozone therapy in 65 patients with fibromyalgia: an effective therapy","volume":"23","author":"Tirelli","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"89","DOI":"10.4081\/reumatismo.2021.1362","article-title":"The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia. Best practices based on current scientific evidence","volume":"73","author":"Ariani","year":"2021","journal-title":"Reumatismo"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.55563\/clinexprheumatol\/ctfuqe","article-title":"Efficacy of physiotherapy treatment in medium and long term in adults with fibromyalgia: an umbrella of systematic reviews","volume":"42","author":"Carrasco-Vega","year":"2024","journal-title":"Clin Exp Rheumatol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1002\/acr.20140","article-title":"The American College of Rheumatology Preliminary Diagnostic Criteria for fibromyalgia and measurement of symptom severity","volume":"62","author":"Wolfe","year":"2010","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"62","DOI":"10.29089\/2020.20.00099","article-title":"Analgetic effect of ozone therapy: myths of reality?","volume":"27","author":"Baranova","year":"2020","journal-title":"Polish Ann Med"},{"key":"ref21","first-page":"507","article-title":"Validaci\u00f3n de la versi\u00f3n espa\u00f1ola del Fibromyalgia Impact Questionnaire","volume":"9","author":"Monterde","year":"2004","journal-title":"Rev Espa\u00f1ola Reumatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1763506\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T13:31:43Z","timestamp":1781098303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1763506\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":21,"alternative-id":["10.3389\/fmed.2026.1763506"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1763506","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"article-number":"1763506"}}