A 35-year-old established female patient returns to the office for a follow-up visit for her diagnosis of fibromyalgia. She complains of pain, stiffness and swelling in her left and right shoulders and her neck. The pain is considerably worse in the morning. She denies any fever, cough or dyspnea. The physician performs a problem-focused exam.
Because of the severity of the neck and upper back pain, the rheumatologist decides to give two trigger-point injections in the right and left trapezius muscles. No medication was changed.