Fibromyalgia causes widespread pain and tenderness. The pain and tenderness tend to come and go, and move about the body.

It is usually associated with poor sleep and is strongly associated with migraine and irritable bowel syndrome.

Assess:

• Severity of pain
• Physical function
• Sleep
• Psychological state
• Social and family function
• Work status/employment issues

History
Widespread pain for at least three months.

Examination
General physical examination including neurological, musculoskeletal to exclude signs of synovitis, mental state assessment. No need to confirm tender points.

Confirm diagnosis
Using either the Fibromyalgia diagnostic criteria or Quick Guide to Fibromyalgia Scoring tools determine whether diagnosis is confirmed. Exclude other conditions that may present with widespread pain.

Rheumatological symptoms, including early morning stiffness, joint swelling or small joint pain.

Pain with fever, weight loss, lymphadenopathy, visual or neurological disturbance.

Pain associated with or related to cancer diagnosis (use 2 week pathway).

Pain with abnormal blood or urine results (raised ESR/anaemia/proteinuria/haematuria).

Please consider the following investigations to exclude other diagnoses, for example (but not limited to):

• Blood tests:
  • Full Blood Count (FBC) 
  • Renal Function Test (RFT) 
  • Liver Function Test (LFT) o Bone Profile 
  • Thyroid Function Test (TFT) 
  • C-reactive protein (CRP) or Plasma Viscosity (PV)
  • HbA1c o Creatine kinase (CK)

• Urine Dipstick (protein, blood and glucose) 
• Additional tests - only if clinically indicated: 
  • Haematinics (ferritin, B12, folate) 
  • Vitamin D (if at risk of deficiency) 
  • Coeliac screen 
  • Serology (if risk of infection - consider: hepatitis, EBV, HIV, CMV) 
  • Myeloma screen (if patient aged over 60yrs) 
  • Cancer screening tests 
  • Imaging
  • Autoimmune (Blood Tests for Rheumatology Conditions)

(N.B. In suspected cases of FMS there is no indication for auto antibody testing e.g. ANA. These tests should only be done when patient have specific CTD symptoms (e.g. Raynaud’s, sicca symptoms etc) 

• Please see Investigations | Diagnosis | Chronic pain | CKS | NICE for further details.

Confirm diagnosis:

Using either the Fibromyalgia diagnostic criteria or Quick Guide to Fibromyalgia Scoring tools determine whether diagnosis is confirmed. Exclude other conditions that may present with widespread pain.

A diagnosis of Fibromyalgia does not mean it is the patient's only diagnosis or even the most important diagnosis. New symptoms and signs should be investigated as appropriate.

Option 1: Continue Management in Primary Care

• Patient education – ReConnect2Life is an interactive programme to help patients look at their pain and how it affects them. It consists of a number of different modules which can be completed in any order.
• Encourage self-management with emphasis on a lifestyle management approach.
• Graded activity: consider physical therapies that engage the patient e.g. physiotherapy, exercise prescription.
• Treat psychological symptoms if prominent. Consider referral to Depression & Anxiety Service or mental health services
• Strong opioids should not be prescribed.

Option 2: Fibromyalgia Pathway

• Provide Moving Forward with Fibromyalgia leaflet so the patient can opt-in to the Fibromyalgia Pathway and education seminars.

Provide Moving Forward with Fibromyalgia leaflet so the patient can opt-in to the pathway and education seminars.

If patient is not suitable for the education seminars and requires a specialist opinion please either seek advice via advice and guidance (A&G) or refer.

Referral Criteria:

Include investigations undertaken to support diagnosis

Referral Instructions

e-Referral Service Selection

• Specialty: Pain Management
• Clinic Type: Pain Management
• Service: DRSS-South Devon & Torbay-Pain Management- Devon ICB - 15N

Patient Information

Reconnect2Life is an interactive programme to help patients look at their pain and how it affects them. It consists of six programme modules plus provides information on seminars and short courses which are run locally.

Sharing this resource with patients will help them understand and manage their pain better.

Reconnect2life website – patient information

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Dr Lyn Margetts – Consultant in Pain Management

Ms Phillipa Newton-Cross – Clinical Lead Physiotherapist in Pain Rehabilitation

Dr Becky Chasey – Lead Clinical Psychologist for the Pain Management Team

Dr Eileen Deakin – GP and Clinical Lead for Long Term Conditions

Publication date: October 2017

Updated: January 2024