Fibromyalgia-Type Chronic Pain
Fibromyalgia is a chronic widespread pain condition involving central nervous system pain processing, diagnosed per the 2016 revised American College of Rheumatology (ACR) diagnostic criteria.
Symptoms
Widespread pain lasting 3 months or longer, along with fatigue, unrefreshing sleep, and cognitive difficulties ("fibro fog"); pain typically affects multiple body regions rather than a single joint or area.
Causes and risk
Central sensitization -- the nervous system becoming more reactive to pain signals -- is the leading explanation, often triggered or worsened by physical or psychological stress, per current NEJM clinical guidance.
How it is evaluated
Diagnosis uses the ACR 2016 criteria (a widespread pain index and symptom severity scale, with pain in 4 of 5 body regions for 3+ months); fibromyalgia is explicitly not a diagnosis of exclusion, meaning it can be diagnosed on its own criteria without first ruling out every other condition, per the ACR criteria.
Treatment
Exercise is the cornerstone of treatment. Duloxetine, milnacipran, and pregabalin are FDA-approved or guideline-supported medications; NSAIDs and opioids are generally not effective for fibromyalgia pain and are discouraged.
When to seek care
New, severe, or one-sided pain that's different from your usual fibromyalgia pattern should be evaluated, since it could signal a separate, treatable problem rather than a fibromyalgia flare.