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Am Fam Physician. 2023;107(2):137-144

Related Letter to the Editor: Low-Dose Naltrexone: A Possible Option for Fibromyalgia

Patient information: See related handout on living with fibromyalgia, written by the authors of this article.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Fibromyalgia is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli. Fibromyalgia is diagnosed more frequently in women and occurs globally, affecting 2% of people in the United States. Patients with fibromyalgia have diffuse chronic pain, poor sleep, fatigue, cognitive dysfunction, and mood disturbances. Comorbid conditions, such as functional somatic syndromes, psychiatric diagnoses, and rheumatologic conditions may be present. The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain. The American College of Rheumatology criteria or the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks–American Pain Society Pain Taxonomy diagnostic criteria can diagnose fibromyalgia. Establishing the diagnosis and providing education can reassure patients and decrease unnecessary testing. A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective. Patient education, exercise, and cognitive behavior therapy can improve pain and function. Duloxetine, milnacipran, pregabalin, and amitriptyline are potentially effective medications for fibromyalgia. Nonsteroidal anti-inflammatory drugs and opioids have not demonstrated benefits for fibromyalgia and have significant limitations.

Fibromyalgia is characterized by diffuse musculoskeletal pain, fatigue, poor sleep, and other somatic symptoms.1 Chronic diffuse pain affects 10% to 15% of adults in the general population worldwide, many of whom have fibromyalgia.2,3 Approximately 2% of people in the United States have fibromyalgia, although the prevalence varies across populations and with the diagnostic criteria used.3 Fibromyalgia can occur in children and adults and is found worldwide and across cultures. Women are diagnosed more frequently than men; a Scottish survey found that women are diagnosed between two and 14 times as often as men depending on the criteria used.3,4 Changes in the diagnostic criteria over the past decade, including the elimination of specific tender points, have resulted in more patients with chronic pain meeting the criteria for fibromyalgia.35

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