Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The cause of fibromyalgia is unknown.


  • Incidence: 60.00 cases per 100,000 person-years
  • Peak incidence: 30-40 years
  • Sex ratio: more common in females 5:1
Condition Relative
Polymyalgia rheumatica1.40
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

  • chronic pain: at multiple site, sometimes 'pain all over'
  • lethargy
  • cognitive impairment: 'fibro fog'
  • sleep disturbance, headaches, dizziness are common


Diagnosis is clinical and sometimes refers to the American College of Rheumatology
classification criteria which lists 9 pairs of tender points on the body. If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely


The management of fibromyalgia is often difficult and needs to be tailored to the individual patient. A psychosocial and multidisciplinary approach is helpful. Unfortunately there is currently a paucity of evidence and guidelines to guide practice. The following is partly based on consensus guidelines from the European League against Rheumatism (EULAR) published in 2007 and also a BMJ review in 2014.
  • explanation
  • aerobic exercise: has the strongest evidence base
  • cognitive behavioural therapy
  • medication: pregabalin, duloxetine, amitriptyline