Diagnostic confounders of chronic widespread pain: not always fibromyalgia

Pain Rep. 2017 Apr 30;2(3):e598. doi: 10.1097/PR9.0000000000000598. eCollection 2017 May.


Introduction: Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis.

Objectives: To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM.

Methods: A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP.

Results: Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented.

Conclusion: Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.

Keywords: Differential diagnosis; Fibromyalgia.

Publication types

  • Review