Summary
Definition
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
1st investigations to order
- clinical diagnosis
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
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 DifferentialsGuidelines
- ACTTION-APS Pain Taxonomy (AAPT) diagnostic criteria for fibromyalgia
- EULAR revised recommendations for the management of fibromyalgia
More GuidelinesPatient leaflets
Fibromyalgia: what is it?
Fibromyalgia: what treatments work?
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