Fibromyalgia

Fatigue affects 35–82% of patients with musculoskeletal disease and roughly one in two reports it as severe — yet it correlates poorly with CRP, DAS28 and even MRI-detected synovitis. This review covers what fatigue is, how to measure it, the biology proposed to explain it, why remission so often fails to resolve it, and what actually works: biologics, exercise, CBT and the EULAR non-pharmacological recommendations.

A 2026 NEJM Clinical Practice review reframing fibromyalgia as nociplastic pain — CNS sensitisation to painful and non-painful stimuli — so therapy aims to calm the CNS rather than repair peripheral tissue. Covers the positive (non-exclusion) diagnosis, the chronic overlapping pain conditions, and management where non-pharmacologic treatment outperforms drugs, amitriptyline at night leads the drugs, and opioids are harmful.