HNY Policy and Pathway Repository - Humber

None provided

• Diagnosis and management should usually be possible in primary care
• Routine referral to secondary care for diagnosis or management is not advised 

Clinical criteria

• Characterised by persistent and widespread pain associated with physical/cognitive/psychological dysfunction
• Use the American College of Rheumatologists (ACR) 2016 diagnostic criteria (see over for link to Royal College of Physicians guidelines, including scoring tool and diagnostic threshold)
• Fibromyalgia is not a diagnosis of exclusion; it may coexist with other condition(s)

Investigations to exclude other conditions:

• FBC
• ESR
• CRP
• TSH
• LFT
• U+E
• CK
• Blood glucose
• Plus anything indicated based on suspicion of other condition(s) arising from the clinical assessment

Management principles

Focus on non-pharmacological therapies, because these are more effective, with an emphasis on education and avoiding drug reliance

May benefit from MDT approach (e.g. provided by Community MSK and Pain Service)

Referral:

• To Community MSK and Pain Service for non-pharmacological therapies +/- MDT approach
• To a relevant specialist service if there is persistent diagnostic uncertainty, particularly if the presentation is complicated by coexisting rheumatological or neurological features or complex comorbidities.

Evidence based guidelines

• Diagnosis of Fibromyalgia - Royal College of Physicians (RCP)
  • The overall guideline includes the scoring tool but there is also a separate diagnostic worksheet with just the scoring tool
  • The diagnosis of fibromyalgia syndrome | RCP London
• Management of Fibromyalgia - European League Against Rheumatism (EULAR)
  • EULAR revised recommendations for the management of fibromyalgia | Annals of the Rheumatic Diseases (bmj.com)
• Pharmacological management - NICE (NG193)
  • Note particularly the recommendations of what NOT to initiate
  • Recommendations | Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain | Guidance | NICE

• Northern Lincolnshire & Goole