Fibromyalgia

This page is currently under review – Nov 23

History

Generalised musculoskeletal pains
Tired all the time and poor sleep
Fatigue and poor concentration
Associated with facial pain, irritable bowel syndrome, tension headaches
History of stressful life events often dating back to childhood.

Examination

Multiple tender spots on palpation (figure). Tender spots are also typical on the anterior trunk

Investigations

Routine bloods (normal)
Anti-CCP antibodies (negative)
X-rays and other imaging are unhelpful except to exclude other diseases.

Referral

Patients with fibromyalgia should not normally be referred to rheumatology unless you are uncertain about the diagnosis. Referral to the pain clinic may be appropriate if the patient’s symptoms don’t respond to the measures outlined in Primary Care Management.