Fibromyalgia is a common chronic syndrome defined by core symptoms of widespread musculoskeletal pain and stiffness throughout the connective tissues that support and move the bones and joints. Other common symptoms include cognitive difficulty, headache, paresthesia, morning stiffness, fatigue, and sleep disturbance. Fibromyalgia is increasingly understood as one of the several disorders that are referred to as central sensitivity syndromes. Tender points are often detected in patients with fibromyalgia. We report a case of 43-year-old female who presented with painful nodule over the palm and later developed generalized pain. Combination therapies with pregabalin, nortriptyline, and ketamine infusion relieved her symptoms over time. The management of fibromyalgia requires a multidimensional approach including patient education, cognitive behavioral therapy, exercise, and pharmacologic therapy. We present a case of fibromyalgia, which was initially treated with a combination of above modalities with partial benefit but actually benefited via ketamine infusion.
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