Intended for healthcare professionals

Clinical Review


BMJ 2014; 348 doi: (Published 24 February 2014) Cite this as: BMJ 2014;348:g1224

This article has a correction. Please see:

  1. Anisur Rahman, professor1,
  2. Martin Underwood, director2,
  3. Dawn Carnes, senior research fellow3
  1. 1Department of Rheumatology, University College London, London WC1E 6JF, UK
  2. 2Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  3. 3Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, London, UK
  1. Correspondence to: A Rahman anisur.rahman{at}

Summary points

  • Symptoms of fibromyalgia are chronic widespread pain associated with unrefreshing sleep and tiredness

  • Fibromyalgia is not a diagnosis of exclusion and often occurs in patients with other conditions, such as inflammatory arthritis and osteoarthritis

  • No clear pathophysiological mechanism for fibromyalgia has been established, but evidence suggests that there is an abnormality in central pain processing

  • Diagnosing fibromyalgia can allow the patient’s polysymptomatic distress to be explained, thereby reducing fear and doubt

  • Fibromyalgia has no cure, but a range of drug and non-drug treatments can reduce symptoms and their impact on the patient’s life

  • Trial evidence for all forms of treatment in fibromyalgia generally shows only small to moderate average effects

Most doctors—particularly rheumatologists, pain specialists, and general practitioners—are familiar with patients who describe chronic pain all over the body, which is associated with a range of other symptoms including poor sleep, fatigue, and depression. This complex of symptoms is sometimes referred to as fibromyalgia. Management of patients with this condition is often complex and challenging. The diagnosis of fibromyalgia has long been controversial, with some experts questioning whether it exists as a separate entity.1 However, the symptoms and distress experienced by patients with fibromyalgia are real. The causes of fibromyalgia are incompletely understood, and optimal management is compromised by the limited evidence base for the available treatments. This article reviews current thinking about what fibromyalgia is, whether it is a useful diagnosis to make, and which drugs and non-drug treatments can be used to treat it.

Sources and selection criteria

We used recommendations from three current guidelines: those from the Canadian Pain Society, the Association of Scientific Medical Societies in Germany (AWMF, 2012; English version, and the European League Against Rheumatism (EULAR, 2008). These were supplemented by data from current Cochrane reviews and a PubMed search for systematic reviews of drug treatment …

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