Patient handout

Fibromyalgia (ACR 2016 WPI/SSS; central sensitisation)

PRODUCTION

1. Your condition

This handout is for fibromyalgia (acr 2016 wpi/sss; central sensitisation). Your care team identified this based on: chronic widespread pain ≥3 months in ≥4 of 5 body regions (acr 2016 wolfe generalised-pain criterion).

Other reasons your team may use this plan: multisite pain + fatigue + unrefreshing sleep + cognitive "fibro-fog" (aapt 2019 arnold); referral for diffuse pain with unremarkable inflammatory / metabolic labs (eular 2017 macfarlane); pain disproportionate to objective disease activity in established ra/sle/oa — fm overlap (wolfe 2016 — fm valid regardless of other diagnoses).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
patient education + self-management	—	—	—	EULAR 2017 Macfarlane — initial management is education + non-pharm; explain nociplastic/central mechanism to legitimise and de-medicalise
graded aerobic exercise	—	physical	progressive, most days	EULAR 2017 ONLY "strong for"; Bidonde 2017 Cochrane CD012700 PMID 28636204 — HRQoL MD -7.89 (95% CI -13.23 to -2.55), pain MD -11.06 (-18.34 to -3.77); well tolerated
progressive resistance exercise	—	physical	2-3x/week, progressive	Busch 2013 Cochrane CD010884 PMID 24362925 — FIQ multidimensional function MD -16.75 (95% CI -23.31 to -10.19), pain MD -3.3/10, leg-extension strength +27.32 kg; safe at moderate-high intensity
cognitive behavioural therapy	—	—	—	Bernardy 2013 Cochrane CD009796 PMID 24018611 — pain SMD -0.29 (end), -0.40 (6 mo); mood SMD -0.33; disability SMD -0.30; durable, no excess dropout
sleep optimisation / CBT-I	—	—	—	Sleep is a core SSS domain; non-pharm sleep management before sedative drugs (EULAR 2017)
multimodal / multidisciplinary rehabilitation	—	—	—	EULAR 2017 Macfarlane — multimodal rehab for severe disability; 2024 physiotherapy umbrella review reaffirms (Carrasco-Vega PMID 38966940)

Plan: Non-pharmacological core — FIRST-LINE (EULAR 2017: exercise the only "strong for"; Macfarlane PMID 27377815)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — managing symptoms, exercising

If you have:

Pain/fatigue at usual manageable baseline
Keeping up graded exercise most weeks
Sleep at personal baseline

Do this:

Keep up your aerobic + strengthening exercise — this is the single most effective treatment (EULAR 2017 strong recommendation)
Maintain regular sleep routine and pacing
Continue any prescribed symptom medication as directed; do not add extra pain pills
Use your coping/relaxation skills proactively, not only in a flare

YELLOW — Flare — symptoms worse than usual

If you have:

Pain, fatigue or "fibro-fog" clearly worse than baseline for several days
Sleep markedly disrupted
New life stressor / overexertion / poor sleep run

Do this:

Do NOT stop exercising — scale back to gentle movement, then rebuild gradually (avoid the rest-deconditioning cycle)
Return to sleep and pacing basics; use CBT/relaxation skills
Do NOT escalate to opioids or add benzodiazepines — these worsen FM long-term (EULAR 2017)
Contact your provider if the flare persists beyond ~2 weeks or function drops

Call your provider if:

Flare not settling after ~2 weeks of self-management
New medication side effects (mood change, marked drowsiness, swelling)

RED — New feature that is NOT typical fibromyalgia

If you have:

New joint swelling/redness, fever, or unexplained weight loss
New muscle weakness (trouble standing from a chair, climbing stairs)
New severe headache / jaw or scalp pain / visual change in age ≥50
New or worsening thoughts of self-harm on your medication

Do this:

Seek prompt medical assessment — these features are NOT explained by fibromyalgia and need evaluation (mimic/coexisting disease)
For thoughts of self-harm, seek urgent/emergency help now
Bring your full medication list including any opioid taper plan

Call your provider if:

Any red-zone trigger — fibromyalgia does not cause objective inflammation, weakness, fever or weight loss; a separate condition must be excluded (Wolfe 2016)
Always seek emergency help for suicidality

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Age ≥50 + new shoulder/hip-girdle pain & morning stiffness + raised ESR/CRP — the PMR/GCA pivot vs FM
Objective proximal weakness + raised creatine kinase — the muscle pivot (statin-induced [drug-induced modifier] / inflammatory myopathy), not FM
SNRI/TCA combined with triptan/tramadol/MAOI/linezolid (serotonin-syndrome risk) OR new suicidality on an antidepressant-class FM drug(life-threatening)

5. Follow-up

Long-term self-management; relapse/flare plan; reinforce sustained exercise and sleep; periodic re-screen for new mimic/comorbidity (TSH, ESR/CRP, CK as indicated); de-prescribe ineffective agents; reassess opioid taper completion (EULAR 2017 Macfarlane; 2024 reaffirming reviews PMID 38855963, 38966940)

6. Sources

Guideline: ACR 2016 revised fibromyalgia criteria (Wolfe, Semin Arthritis Rheum 2016) + EULAR 2017 revised management recommendations (Macfarlane, Ann Rheum Dis) + AAPT 2019 (Arnold, J Pain). No superseding FM society guideline at the 2026 floor (verified 2026-05-16; depth-pass-2 evidence reconciled 2026-05-17; evidence-gap noted in notes).