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Last reviewed: 1 Nov 2023
Last updated: 27 Oct 2020



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, odors, noises
Other diagnostic factors

Risk factors

  • family history of fibromyalgia
  • rheumatologic 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
  • CBC
  • rheumatoid factor
  • anti-cyclic citrullinated protein (CCP) antibody
  • antinuclear antibody
  • vitamin D level
More investigations to consider

Treatment algorithm


all patients



Daniel J. Clauw, MD

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 reviewers

Don Goldenberg, MD

Emeritus Professor of Medicine

Tufts University School of Medicine




DG declares that he has no competing interests.

Robert Bennett, MD

Professor of Medicine and Nursing Research

Oregon Health & Science University




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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