Fibromyalgia

Borders Ref Help Toolkit
NHS Borders

History

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

Examination

  •  No joint swelling or deformity
  • Generalised tenderness of joints and muscles
  • Hypersensitivity to touch
  • Tender points are no longer required to make a diagnosis

Investigations

  • Blood count, renal and liver function, bone profile, thyroid function, CK – normal
  • ESR and CRP normal, mild elevations may be seen with high body mass index and are not necessarily suggestive of inflammatory disease
  • Do not check for rheumatoid arthritis related antibodies or connective tissue disease screen if no specific features of these conditions are present
  • X-rays and other imaging are unhelpful except to exclude other diseases.

Who to refer, who not to refer, how to refer

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.

Primary care management

Management

Treatment is symptomatic. Associated depression may also require treatment

Education:

  • Explain that they have fibromyalgia and it’s a condition where the perception of pain is abnormal.
  • Explain that there is no cure but treatments are available to help control pain. Explain the importance of pacing activities

Pain control:

  • Analgesics and NSAIDs are seldom helpful
  • Gabapentin – but do not continue if not helpful
  • Amitriptyline – low dose 10 mg at night and increase until sleep pattern is restored.  Stop if 50 mg is reached without benefit
  • Sleep disturbance:
    • General advice on sleep hygiene

Physiotherapy:

  • Graded exercise programme

Clinical psychology:

  • Cognitive behaviour therapy

Please see Resources and links tab for additional information

Resources and links

https://www.rcp.ac.uk/media/udlhnt1b/the-diagnosis-of-fibromyalgia-syndrome-guidelines_1_2_0.pdf

Editorial Information

Last reviewed: 23/07/2025

Next review date: 23/07/2027

Author(s): Ruth Richmond .

Author email(s): rheumatology@borders.scot.nhs.uk.