Last reviewed: 6 Apr 2021
Last updated: 27 Oct 2020



History and exam

Key diagnostic factors

  • chronic pain
  • diffuse tenderness on examination

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, odors, noises

Risk factors

  • family history of fibromyalgia
  • rheumatologic conditions
  • age between 20 and 60 years
  • female sex
  • presence of associated conditions

Diagnostic investigations

Investigations to consider

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

Treatment algorithm


Professor of Anesthesiology, Medicine, and Psychiatry

University of Michigan Health System

Ann Arbor



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.

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


LWC declares that she has no competing interests.

Peer reviewersVIEW ALL

Emeritus Professor of Medicine

Tufts University School of Medicine




DG declares that he has no competing interests.

Professor of Medicine and Nursing Research

Oregon Health & Science University




RB declares that he has no competing interests.

Use of this content is subject to our disclaimer