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Fibromyalgia N073

Last amended 
1 August 2019
Current RMA Instruments
Reasonable Hypothesis SOP
13 of 2014
Balance of Probabilities SOP
14 of 2014
Changes from previous Instruments

SOP Bulletin 171

 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 pathology, 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.  There are no confirmatory laboratory or other tests.  Diagnostic criteria are available, based on pain locations and symptom severity.

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.