General Overview

  • If accompanied by widespread pain (typically in muscles and joints), consider Fibromyalgia, requires all of:
    • Widespread pain index (WPI) ≥ 7 and symptom severity (SS) scale score ≥ 5 or WPI 3-6 and SS scale score ≥ 9
      • Shoulder, hip, jaw, chest, abdomen, upper/lower arm/leg/back
      • Fatigue, waking unrefreshed, cognitive symptoms
    • Symptoms present at similar level for ≥ 3 months
    • Absence of disorder that would otherwise explain pain


  • Psychotherapy
  • Graduated exercise program (aerobic, resistance-training)
  • Tai-Chi
  • Low evidence for raw vegetarian diet

Consider pharmacologic treatment

  • Amitryptyline 25-50mg PO qHS (most evidence)
  • Pregabalin 150-450mg/day in divided doses
  • Cyclobenzaprine 5-20mg PO qHS (sleep)
  • Duloxetine 60mg PO daily (pain)
  • Paroxetine, Fluoxetine