Fibromyalgia Referral Guideline

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Fibromyalgia (FMS) is a syndrome of chronic widespread pain and tenderness associated with fatigue, unrefreshing sleep and perception of cognitive dysfunction. There is no organic muscle or joint pathology.

Diagnosis of the condition should be primarily conducted in primary care however a secondary care referral should occur when there is diagnostic uncertainty.

History

  • Chronic widespread pain (3 or more months of generalised pain, affecting both sides of the body and above and below the waist, with no other explanation)
  • Widespread tenderness
  • Fatigue
  • Non-refreshed sleep
  • Mood disturbance
  • Cognitive impairment

Examination

Widespread tenderness.

Previous diagnostic criteria for fibromyalgia have included specific tender points on examination but these have proved hard to standardise and are not required for diagnosis.

Helpful Investigations

Fibromyalgia is a clinical diagnosis. There are no specific diagnostic tests. Simple blood tests are normal although FMS can coexist with other diseases.

  • U&E, LFT, TFT, bone profile
  • ESR and CRP

Primary Care Management

Who to Refer

  • Patients with joint swelling and tenderness.
  • Patients with joint pain and elevated inflammatory markers (ESR and CRP).
  • Patients in whom there is clinical suspicion of underlying connective tissue disease – patients with a photosensitive rash, Raynaud’s, recurrent oral ulceration or sicca symptoms and a positive ANA. A weakly positive (1:40 or 1:160) antinuclear antibody (ANA) is a common laboratory finding (seen in up to 15% of healthy people) and unless there are clinical features to suggest a connective tissue disorder, these patients will not require Rheumatology review.

Who Not to Refer

  • Patients with generalized pain and/or fatigue with no other symptoms or signs and with normal simple test results.
  • Patients who have previously been discharged from Rheumatology with a diagnosis of fibromyalgia/widespread pain are very unlikely to benefit from further review and the process may simply delay referral to the Pain service.

Last reviewed: 01 November 2020

Next review: 01 November 2022

Author(s): Dr Anna Ciechomska

Co-Author(s): Rheumatology team: Dr Robin Munro, Dr Karen Donaldson, Dr Elizabeth Murphy, Dr James Dale, Dr Sanjiv Nandwani, Dr Georgiana Young, Dr May Chee, Mr Nico Groenendijk; GP representatives: Dr Tyra Smith, Dr Mark Russell, Dr Linda Findlay, Dr Paul Deehan, Dr Lucy Munro; Medical directorate: Dr Mehrdad Malekian

Approved By: Dr Karen Donaldson

Reviewer Name(s): Dr Anna Ciechomska