Fibromyalgia Diagnosis and Treatment

Core Clinical Symptoms

• The American College of Rheumatology recommends that fibromyalgia be diagnosed based on generalized, widespread chronic pain (≥3 months duration) with multiple tender points upon physical examination, reduced pain threshold with hyperalgesia and allodynia, fatigue, and non-refreshed sleep 1, 2, 3, 4, 5
• Fibromyalgia patients often experience cognitive dysfunction, mood disturbances, headache, migraine, variable bowel habits, diffuse abdominal pain, and urinary frequency 2, 3, 4, 5

Treatment Algorithm

• The European League Against Rheumatism recommends beginning with patient education and non-pharmacological therapies, including exercise therapy, which is the only "strong for" recommendation based on meta-analyses 2
• The American College of Rheumatology suggests that for severe pain or sleep disturbance, FDA-approved medications such as pregabalin and duloxetine should be added as first-line pharmacological options 1
• Cognitive behavioral therapy is recommended for mood disorders and unhelpful coping strategies, and should be combined with exercise therapy for severe disability 2, 6

Critical Pitfalls to Avoid

• The Centers for Disease Control and Prevention advises against prescribing NSAIDs or opioids as primary therapy for fibromyalgia, due to limited evidence for long-term effectiveness and significant risks of addiction and overdose 1, 6, 7
• Monotherapy is usually insufficient, and combination therapy addressing multiple symptom domains is most effective 6