10.2.1 Fibromyalgia

Prescribing Notes

• Fibromyalgia is a type of chronic primary pain. Chronic primary pain has no clear underlying condition or is out of proportion to any observable injury or illness.
• Recommended management options are mainly non-pharmacological – see 4.7.2 and NICE NG193.
• Antidepressants (amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline) can be considered even in the absence of depression. Note this is off-label use.
• Do not initiate opioids, NSAIDs, paracetamol, antiepileptic drugs (including gabapentinoids), antipsychotics, benzodiazepines, local anaesthetics, corticosteroid +/- local anaesthetic trigger point injections or ketamine.
• Chronic primary pain can co-exist with other secondary causes of pain, e.g. low back pain and sciatica which have specific guidance – see 4.7.2 .