Fibromyalgia

• Widespread pain for at least 3 months, fatigue, sleep disturbance, cognitive problems (central sensitisation, not inflammation).

• Diagnosis: 2016 ACR criteria (Widespread Pain Index and Symptom Severity Score); tender points not needed.

• Tests only to exclude other causes: ESR, CRP, CK, thyroid function, vitamin D in selected patients; no routine autoimmune serology.

Management

• Education; regular graded aerobic exercise and strength training; cognitive behavioural therapy; sleep hygiene; stress reduction.

• S: Duloxetine (PO) 30–60 mg once daily, OR A: amitriptyline (PO) 25 mg once daily.