Last reviewed: August 2020
Last updated: May  2018



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
  • fluid retention
  • sensitivity to sensory stimuli such as bright lights, odors, noises

Risk factors

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

Diagnostic investigations

Investigations to consider

  • ESR/C-reactive protein
  • TFT
  • CBC
  • rheumatoid factor
  • anti-cyclic citrullinated protein (CCP) antibody
  • ANA
  • vitamin D level
More investigations to consider

Treatment algorithm


Professor of Medicine

Division of Rheumatology

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, Perdue Pharmaceudicals, Zynerba, Astellas Pharmaceuticals, Williams & Connolly LLP, and Theravance; he has received research grant support from Pfizer, Cypress Biosciences, Forest Laboratories, Merck, Novo, and Cerephex. DJC is an author of a number of references cited in this monograph.

Dr Daniel J. Clauw would like to gratefully acknowledge Dr Lisa Ware Corbin, a previous contributor to this monograph. LWC declares that she has no competing interests.

Peer reviewersVIEW ALL

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