GPAtlas🧭 When to suspect
Fibromyalgia is a long-term condition in which the nervous system becomes over-sensitised and amplifies pain signals. The patient feels widespread pain, exhaustion, poor-quality sleep and “brain fog” – with no inflammation or tissue damage to find.
This mechanism is called nociplastic pain (dysfunction in the central nervous system pathways, including amplified pain-signal processing, and decreased signalling of the descending pain inhibitory pathway).
Fibromyalgia is not an inflammatory or autoimmune disease, and it is not “all in the mind”. NICE classifies it as a form of chronic primary pain.
Fibromyalgia is common – around 2% of adults.
• It mostly affects women (roughly 80–90% of UK diagnoses).
• It usually presents between 30 and 60, though it occurs in men, younger and older people too.
The practical point for primary care is that fibromyalgia is a positive, clinical diagnosis a GP can make:
• Recognise the pattern.
• Run a short screen to exclude mimics.
• Start management.
Referral to rheumatology purely to “confirm” it is not needed.
| Feature | What you'll typically hear |
|---|---|
| Widespread pain (the core feature) | • Aching or burning pain affecting most of the body for ≥ 3 months • Often moves around and varies day to day |
| Fatigue | Persistent tiredness, often worse after activity. |
| Unrefreshing sleep | Wakes tired however long they sleep. |
| Cognitive symptoms | Poor concentration and memory – “fibro fog”. |
| Sensory sensitivity & companions | • Heightened sensitivity to noise, light, touch or temperature • Commonly with headaches, IBS-type symptoms, low mood and morning stiffness |
The American College of Rheumatology (ACR) 2016 criteria formalise this pattern and can support the diagnosis, but fibromyalgia is recognised clinically – not by a questionnaire alone. Symptoms are often triggered by physical or psychological trauma, infection or major stress, and there is frequently a family history.
Source: NICE NG193 · RCP UK clinical guidelines 2022 · ACR 2016 criteria
|
🧠 Clinical pearl • Fibromyalgia is not a diagnosis of exclusion. • You don't need to rule out everything first – a recognisable pattern plus a normal short screen is enough to diagnose it positively. • Fibromyalgia can sit alongside conditions like rheumatoid arthritis or lupus. • A confident, validating diagnosis is itself part of the treatment. • Uncertainty and repeated “we're still looking” messages make patients worse. |
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