Fibromyalgia or chronic pain syndrome
Diagnose based on chronic widespread pain ≥3 months with fatigue, cognitive dysfunction; use Fibromyalgia Rapid Screening Tool; exclude other conditions
Tricyclic antidepressants (amitriptyline), serotonin–norepinephrine reuptake inhibitors (duloxetine, milnacipran), gabapentinoids (pregabalin); avoid opioids and NSAIDs (ineffective)
None specific; evaluate TSH, vitamin D/B12, ESR/CRP to rule out other disorders
None (imaging typically normal); may use imaging to exclude other causes
Chronic widespread musculoskeletal pain, fatigue, nonrestorative sleep, cognitive difficulties such as fibro fog, anxiety or depression
Regular follow up every 3–6 months; adjust therapy and monitor symptom burden
Aerobic and resistance exercise, cognitive behavioral therapy, stress reduction, sleep hygiene, complementary therapies (yoga, tai chi, mindfulness)
Refer to rheumatologist or pain specialist; physical therapy; mental health support; support groups