How can I differentiate fibromyalgia from other chronic pain conditions in a primary care setting?

To differentiate fibromyalgia from other chronic pain conditions in a primary care setting, focus on its characteristic clinical features and the absence of an identifiable underlying cause that explains the pain. Fibromyalgia is classified as a type of chronic primary pain, where the pain or its impact is disproportionate to any observable injury or disease, distinguishing it from chronic secondary pain conditions where a clear underlying pathology exists NICE NG193.

Fibromyalgia typically presents with widespread musculoskeletal pain lasting more than 3 months, accompanied by other symptoms such as fatigue, sleep disturbances, cognitive difficulties, and psychological distress, which are prominent and contribute to significant disability Peterson 2007. The pain is often diffuse rather than localized, unlike conditions such as osteoarthritis or neuropathic pain where pain distribution corresponds to specific anatomical or neurological patterns NICE NG193; Masi & Vincent 2015.

In primary care, a person-centred assessment is essential, exploring the patient's pain experience, its impact on daily life, and associated symptoms, while carefully excluding red flags or signs of serious underlying pathology that would warrant urgent referral NICE CKS,NICE NG193. The absence of objective findings on examination or investigations that adequately explain the severity and distribution of pain supports a diagnosis of fibromyalgia NICE NG193; Peterson 2007.

Fibromyalgia can coexist with other chronic pain conditions, so clinical judgement is required to differentiate and manage overlapping symptoms NICE NG193. Unlike some other chronic pain syndromes, fibromyalgia does not respond well to typical analgesics or anti-inflammatory drugs, and management focuses on non-pharmacological approaches such as supervised exercise programmes and cognitive behavioural therapies NICE CKS,NICE NG193; Masi & Vincent 2015.

In summary, differentiating fibromyalgia involves identifying widespread chronic primary pain with associated systemic symptoms, absence of a clear secondary cause, and a significant impact on quality of life, supported by a thorough clinical assessment and exclusion of other diagnoses NICE NG193; Peterson 2007.