Adults
Fibromyalgia
Chronic widespread pain with fatigue, unrefreshing sleep and cognitive symptoms. Inflammatory markers and exam are normal.
What to look for
- Widespread pain for 3 months or more, fatigue, unrefreshing sleep, cognitive difficulty
- Normal joint exam apart from tenderness, and normal inflammatory markers
- Often coexists with other conditions, including inflammatory disease
What to do
- A focused workup is enough: CBC, metabolic panel, ESR/CRP, TSH, plus CK if on a statin or weak.
- Avoid broad autoantibody panels without specific features.
- Graded aerobic exercise has the strongest evidence. Add sleep and mood care and CBT.
- Medication options include duloxetine, milnacipran, pregabalin, low-dose amitriptyline, and sublingual cyclobenzaprine (FDA-approved for fibromyalgia in 2025). Avoid opioids.
Refer if
- Objective joint swelling, raised inflammatory markers or other signs of inflammatory disease
- Real diagnostic uncertainty, or no response to several treatment steps
About this urgency level
Common in referral queues. Many can be managed in primary care with the guidance below, though some rheumatology practices are happy to see them. A pre-referral e-consult can help decide.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.