We are pleased to confirm that the new Fibromyalgia Diagnostic and Management Pathway is available on DXS for use in primary care. This pathway has been developed collaboratively with key stakeholders across Primary and Secondary Care and aligns with NICE NG193, the GIRFT Rheumatology Report (2021), and RCP guidance. It is designed to support clinicians in confidently diagnosing and managing fibromyalgia within primary care, noting that routine referral to secondary care for diagnosis is not recommended. 

The pathway includes the RCP Fibromyalgia Diagnostic Worksheet and emphasises diagnosis through clinical assessment after ruling out other conditions. It also outlines the recommended first line management options, including education, graded aerobic and resistance-based exercise, psychological support, and the limited but potential role of medications such as amitriptyline or duloxetine. 

As part of this work, the Rheumatology fibromyalgia section of the DXS Rheumatology, MSK and Pain referral form has been amended to reflect the updated pathway and avoid confusion. These changes aim to reduce confusion, ensure appropriate use of investigations, and promote timely management in primary care.  

If specialist Rheumatology input is required for consideration of an autoimmune/inflammatory disorder as an alternative diagnosis, please use eRS Advice and Guidance Rheumatology service in the first instance and provide the relevant details (ideally using the DXS referral form). Where clinically appropriate, the Rheumatology team can convert the A&G request into a referral and book an appointment to review the patient. 

The updated pathway can be found in the following location on DXS: Frimley Health and Care / Rheumatology folder or using the search terms of: Fibro, Fibromyalgia, FHC3827. 

The updated referral form can be found in the following location on DXS: Frimley Health and Care/Rheumatology folder using the search terms of: Ortho, MSK, Rheumatology, Pain, FHC1830