Fibromyalgia

Last reviewed: 2 Nov 2022
Last updated: 09 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • chronic pain
  • diffuse tenderness on examination
More key diagnostic factors

Other diagnostic factors

  • fatigue unrelieved by rest
  • sleep disturbance
  • mood disturbance
  • cognitive dysfunction
  • headaches
  • numbness/tingling sensations
  • stiffness
  • sensitivity to sensory stimuli such as bright lights, odours, noises
Other diagnostic factors

Risk factors

  • family history of fibromyalgia
  • rheumatological conditions
  • age between 20 and 60 years
  • female sex
  • presence of associated conditions
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • erythrocyte sedimentation rate/CRP
  • thyroid function test
  • FBC
  • rheumatoid factor
  • anti-cyclic citrullinated protein (CCP) antibody
  • antinuclear antibody
  • vitamin D level
More investigations to consider

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Daniel J. Clauw, MD

Professor of Anesthesiology, Medicine, and Psychiatry

University of Michigan Health System

Ann Arbor

MI

Disclosures

DJC has received consulting fees from Pfizer, Eli Lilly, Nuvo, Cerephex, Tonix, Abbott, Forest Laboratories, Johnson & Johnson, Merck, Purdue Pharma, Zynerba, Astellas Pharmaceuticals, Williams & Connolly LLP, and Aptinyx; he has received research grant support from Pfizer, Cypress Biosciences, Forest Laboratories, Merck, Novo, Cerephex, and Aptinyx. DJC is an author of a number of references cited in this topic.

Acknowledgements

Dr Daniel J. Clauw would like to gratefully acknowledge Dr Lisa Ware Corbin, a previous contributor to this topic.

Disclosures

LWC declares that she has no competing interests.

Peer reviewers

Don Goldenberg, MD

Emeritus Professor of Medicine

Tufts University School of Medicine

Boston

MA

Disclosures

DG declares that he has no competing interests.

Robert Bennett, MD

Professor of Medicine and Nursing Research

Oregon Health & Science University

Portland

OR

Disclosures

RB declares that he has no competing interests.

  • Differentials

    • Myofascial pain syndrome (MPS)
    • Vitamin D deficiency
    • Chronic fatigue syndrome (CFS)
    More Differentials
  • Guidelines

    • ACTTION-APS Pain Taxonomy (AAPT) diagnostic criteria for fibromyalgia
    • EULAR revised recommendations for the management of fibromyalgia
    More Guidelines
  • Patient leaflets

    Fibromyalgia: what is it?

    Fibromyalgia: what treatments work?

    More Patient leaflets
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