{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:24:35Z","timestamp":1787649875240,"version":"build-2736575974"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Fibromyalgia (FM) is a clinical syndrome characterized by chronic widespread pain and various functional symptoms. Although multiple treatments have been proposed for FM, therapeutic options remain limited for patients who do not respond adequately to conventional treatments. This case report describes a woman in her late 50s with refractory FM who received ultrasound-guided vagus nerve-targeted pharmacopuncture (UGP) as an adjunct to multimodal Korean medicine treatment. The patient presented with widespread pain, xerostomia, dyspepsia, headache, palpitations, and insomnia. Multimodal treatment included manual acupuncture, electroacupuncture, routine pharmacopuncture, wet cupping, and herbal medicine, with two additional UGP sessions administered during the treatment period. During the treatment course, the patient\u2019s pain intensity decreased from 7 to 2 on the numeric rating scale, accompanied by improvements in sleep, fatigue, anxiety, depression, and patient-reported autonomic symptoms. Heart rate variability parameters also changed between baseline and the 3-month follow-up. No serious or persistent procedure-related adverse events were observed. However, because UGP was administered as part of a multimodal treatment program and HRV was assessed at only two time points, the specific contribution of UGP to the clinical and physiological changes could not be determined. This case provides a hypothesis-generating observation that warrants further investigation of vagus nerve-targeted interventions in FM.<\/jats:p>","DOI":"10.3389\/fmed.2026.1870404","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:10:17Z","timestamp":1787649017000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adjunctive ultrasound-guided vagus nerve-targeted pharmacopuncture for refractory fibromyalgia with autonomic symptoms: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Ju-Hyun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Medical Support, Imsil-gun Medical Center","place":["Imsil, Republic of Korea"]},{"name":"The Academy of Korean Medicine Clinical Anatomy","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Ung","family":"Lee","sequence":"additional","affiliation":[{"name":"The Academy of Korean Medicine Clinical Anatomy","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan-Hyuk","family":"Choi","sequence":"additional","affiliation":[{"name":"The Academy of Korean Medicine Clinical Anatomy","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suji","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Acupuncture and Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seunghoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Acupuncture and Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/1471-2474-8-27","article-title":"An internet survey of 2,596 people with fibromyalgia","volume":"8","author":"Bennett","year":"2007","journal-title":"BMC Musculoskelet Disord"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1001\/jama.2014.3266","article-title":"Fibromyalgia: a clinical review","volume":"311","author":"Clauw","year":"2014","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s11920-003-0045-x","article-title":"Fibromyalgia: an overview","volume":"5","author":"Thompson","year":"2003","journal-title":"Curr Psychiatry Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1016\/j.semarthrit.2008.12.003","article-title":"Prevalence of fibromyalgia: a survey in five European countries","volume":"39","author":"Branco","year":"2010","journal-title":"Semin Arthritis Rheum"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"21501319221094169","DOI":"10.1177\/21501319221094169","article-title":"Prevalence and incidence of patients with fibromyalgia in Catalonia between 2010 and 2017: a descriptive observational study","volume":"13","author":"Sauch Valma\u00f1a","year":"2022","journal-title":"J Prim Care Community Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1002\/art.1780380104","article-title":"The prevalence and characteristics of fibromyalgia in the general population","volume":"38","author":"Wolfe","year":"1995","journal-title":"Arthritis Rheum"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"957","DOI":"10.55563\/clinexprheumatol\/buhd2z","article-title":"Fibromyalgia: one year in review 2025","volume":"43","author":"Iannuccelli","year":"2025","journal-title":"Clin Exp Rheumatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1186\/ar2146","article-title":"Biology and therapy of fibromyalgia. 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