Fibromyalgia

Other

Overview

Fibromyalgia is a central sensitisation syndrome characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. It is diagnosed clinically using the 2016 ACR criteria and is not associated with structural tissue damage.

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Medically Managed — Refer Early

This condition is primarily medically managed. Osteopathic care may play a supportive role — refer early if suspected.

Typical Presentation

Site

Widespread, bilateral, above and below the waist; often includes axial pain

Quality

Deep aching, burning, heaviness; allodynia and hyperalgesia common

Intensity

Variable; typically moderate to severe with significant functional impact

Aggravating

Physical or psychological stress, poor sleep, cold, inactivity

Relieving

Graded activity, sleep improvement, pain neuroscience education, stress management

Associated

Fatigue, brain fog, IBS, headaches, mood disturbance, sleep disorder

⚠ Red Flags

  • •Objective joint swelling or synovitis suggesting inflammatory arthropathy
  • •Elevated inflammatory markers (ESR, CRP) or positive ANA suggesting connective tissue disease
  • •Progressive neurological deficit suggesting CNS pathology
  • •Unintentional weight loss suggesting malignancy

⚡ Yellow Flags

  • •High catastrophising and fear-avoidance significantly limiting function
  • •Comorbid depression or anxiety amplifying pain experience
  • •Illness identity strongly tied to diagnosis limiting engagement with active therapies

Referral Criteria

  • •GP referral for diagnostic workup and exclusion of inflammatory or systemic conditions
  • •Rheumatology if connective tissue disease suspected
  • •Pain psychology or multidisciplinary pain clinic for central sensitisation management
  • •Psychiatry or psychology if comorbid mental health is primary driver