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Fibromyalgia

Last reviewed: 10 Nov 2024
Last updated: 08 Dec 2023

Summary

Definition

History and exam

Key diagnostic factors

  • widespread pain and stiffness
  • sleep disturbance/fatigue
  • cognitive difficulties
Full details

Other diagnostic factors

  • allodynia and/or hyperalgesia
  • diffuse tenderness on exam
  • sensitivity to sensory stimuli
  • headaches
  • mood disturbance
  • numbness/tingling sensations
Full details

Risk factors

  • family history of fibromyalgia (FM)
  • rheumatologic conditions
  • age between 20 and 60 years
  • female sex
  • stressful events
  • sleep problems
  • infections
  • vitamin D deficiency
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • erythrocyte sedimentation rate (ESR)/CRP
  • thyroid function test
  • CBC
  • rheumatoid factor
  • anti-cyclic citrullinated protein (CCP) antibody
  • antinuclear antibody or anti-DNA antibody
  • vitamin D level
  • creatinine kinase
  • ferritin
  • overnight oximetry/polysomnography
Full details

Treatment algorithm

ONGOING

mild or moderate fibromyalgia

severe fibromyalgia

Contributors

Authors

Matthew A. Bartlett, MB, BCh, BAO

Assistant Professor of Medicine

Fibromyalgia Clinic

Division of General Internal Medicine

Department of Internal Medicine

Mayo Clinic

Rochester

MN

Disclosures

MAB declares that he owns stock in Johnson & Johnson. No products developed or marketed by Johnson & Johnson are included in this topic.

​Christopher V. Anstine, MD

Assistant Professor of Medicine

Fibromyalgia Clinic

Division of General Internal Medicine

Department of Internal Medicine

Mayo Clinic

Rochester

MN

Disclosures

CVA declares he has no competing interests.

Acknowledgements

Dr Matthew A. Barlett and Dr Christopher V. Anstine would like to gratefully acknowledge Dr Daniel J. Clauw and Dr Lisa Ware Corbin, previous contributors to this topic.

Disclosures

LWC and DJC declare that they have 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

    • Rheumatoid arthritis (RA)
    • Polymyalgia rheumatica (PMR)
    • Systemic lupus erythematosus (SLE)
    More Differentials
  • Guidelines

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

    Fibromyalgia: what is it?

    Fibromyalgia: what treatments work?

    More Patient information
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