Fibromyalgia: Diagnosis, differential, and evidence‑based management

Fibromyalgia (FM) is a chronic centralized pain syndrome characterized by widespread pain, fatigue, sleep disturbance, and cognitive symptoms. Although not an inflammatory or degenerative disease, FM is highly prevalent, disabling, and frequently coexists with rheumatic, metabolic, and psychiatric conditions. This narrative review summarizes diagnostic criteria, red‑flag differentials, a rational workup, and current evidence for non‑pharmacologic and pharmacologic management from 2000–2025. Exercise therapy, education, and cognitive‑behavioral interventions consistently provide small‑to‑moderate benefits with the best risk–benefit profile; medications such as duloxetine, milnacipran, pregabalin, and low‑dose amitriptyline yield modest pain and sleep improvements. Opioids and benzodiazepines are discouraged. A multimodal, patient‑centered, stepped‑care approach remains the cornerstone of treatment.