Abstract
Fibromyalgia is a constellation of pain and psychological symptoms and is a diagnosis of exclusion. It can be physically and emotionally taxing to patients, sometimes interfering with their daily lives. Etiology of fibromyalgia is unknown but it is thought to be a disorder of central sensitization with CNS. American College of Rheumatology diagnostic tool for fibromyalgia is used for diagnoses of fibromyalgia and includes generalized pain (in ≥4 out of 5 regions), Symptoms for ≥3 months, Widespread pain index (WPI) ≥7 and symptom severity scale (SSS) score ≥5; OR WPI 4–6 and SSS ≥9, no other diagnoses can be made from clinical presentation. Treatment should be multidisciplinary including pharmacological and nonpharmacologic measures: patient education, treatment of comorbidity, slow graded exercise as tolerated; if symptoms do not improve, may add low dose TCA vs SNRI nightly +/− gabapentinoids; other medications including low dose naltrexone may be trialed.