Fibromyalgia

Fibromyalgia is a chronic pain condition characterised by widespread pain, fatigue, sleep disturbance and other symptoms. Contemporary models emphasise altered pain processing and nociplastic mechanisms, with contributions from biological, psychological and social factors. Central sensitisation may contribute to symptoms, but fibromyalgia should not be reduced to a single mechanism or described as being caused solely by the central nervous system.

Patients commonly report widespread pain, fatigue, unrefreshing sleep and cognitive difficulties, sometimes accompanied by headaches, irritable bowel symptoms, sensory sensitivity and mood symptoms. Diagnosis is clinical and uses established criteria; routine investigations are directed at excluding or identifying other conditions when clinically indicated rather than requiring extensive testing in every patient.

Treatment is primarily multidisciplinary and focuses on education, graded physical activity or exercise, sleep management and strategies that improve function and reduce distress. Psychological therapies such as cognitive behavioural therapy can be useful, and selected medicines including duloxetine, milnacipran or pregabalin may help some patients. Interventional procedures are generally not central to fibromyalgia management unless there is a separate, treatable focal pain generator.