Fibromyalgia is a chronic condition of widespread pain with fatigue, poor sleep and trouble thinking, caused by a nervous system that amplifies pain signals. It does not damage joints or muscles, and it is best managed with exercise and a mix of treatments.
Key symptoms
- Widespread pain on both sides of the body for 3 months or more
- Fatigue and unrefreshing sleep
- Trouble with memory and focus (fibro fog)
- Headaches, irritable bowel symptoms, anxiety or low mood
What you find on exam
- Diffuse tenderness to light pressure
- Normal joints with no swelling or synovitis
- Normal strength and neurologic exam
- Screening for depression and anxiety
Tests
- Clinical diagnosis with the widespread pain index and symptom severity score
- Basic labs to rule out mimics: blood count, ESR or CRP, TSH
- No broad autoimmune panels without signs of another disease
Treatment basics
- Education and reassurance that the pain is real
- Regular aerobic exercise, starting slowly
- Cognitive behavioral therapy and sleep hygiene
- Duloxetine, pregabalin or low-dose amitriptyline
- Avoid opioids
Red flags
- Joint swelling, rash or high inflammatory markers
- Weight loss, fever or night sweats
- Suicidal thoughts
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.