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Fibromyalgia N073

Last amended 
4 November 2021
Current RMA Instruments
Reasonable Hypothesis SOP
107 of 2021
Balance of Probabilities SOP
108 of 2021
Changes from previous Instruments

SOP Bulletin 226

 ICD Coding
  • ICD-9-CM Codes: 729.1
  • ICD-10-AM Codes: M79.7
Brief description

Fibromyalgia is a controversial disorder, with no established organic basis.  It manifests with chronic widespread musculoskeletal pain that is often accompanied by fatigue, sleep disturbance, cognitive disturbance, psychiatric symptoms, and other somatic symptoms. In this disorder there is no objective evidence of local pathology at the pain sites, but a central pain sensitisation mechanism may be responsible. 

Confirming the diagnosis 

Fibromyalgia is a clinical diagnosis, based on duration of symptoms, widespread pain in multiple sites, associated features, and the exclusion of other conditions that could account for the symptoms.  The clinical criteria contained in the SOP defintion need to be met for the SOP to be applied. There are no confirmatory laboratory or other tests.  

The relevant medical specialist is a rheumatologist.

Additional diagnoses covered by SOP
  • Nil
Conditions excluded from SOP
  • Symptom or manifestation of psychiatric conditions such as depression. 
  • Conversion disorder#
  • Chronic fatigue syndrome*
  • Somatic symptom disorder* 
  • Complex regional pain syndrome*

* Another SOP applies

# Non-SOP condition

Clinical onset

Clinical onset will be based on when relevant symptoms first developed.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  The condition is difficult to treat.  Some people have improvement in symptoms with a multidisciplinary treatment approach, but some people are unresponsive to available treatment options.