Fibromyalgia — FRCA Final MCQ

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ModeratePain MedicineFibromyalgiaFRCA Final

A 32-year-old woman with fibromyalgia has widespread pain, fatigue, cognitive symptoms and disturbed sleep. Following a person-centred assessment, she wishes to discuss drug treatment alongside a supervised exercise programme. According to NICE guidance for chronic primary pain, which treatment is most appropriate to consider initiating?

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Correct answer: B — Duloxetine

Fibromyalgia is classified by NICE as chronic primary pain. **Duloxetine** is one of the antidepressants that may be considered after discussing benefits and harms; antidepressants may improve pain, sleep, quality of life and psychological distress even without depression. NICE does not prefer duloxetine over every other listed antidepressant, but it is the only appropriate option here. Morphine and naproxen should not be initiated because opioids and NSAIDs lack demonstrated benefit and may cause harm. NICE also advises against initiating local anaesthetics, including topical preparations, or corticosteroid trigger-point injections for chronic primary pain. Pregabalin was removed from the original option because NICE specifically advises against initiating gabapentinoids for fibromyalgia as chronic primary pain.

Reference: National Institute for Health and Care Excellence. NG193, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, recommendations 1.2.7–1.2.10, 2021. https://www.nice.org.uk/guidance/ng193/chapter/recommendations