When should I consider referring a patient with fibromyalgia to a specialist for further evaluation?

Consider referring a patient with fibromyalgia to a specialist when there is diagnostic uncertainty, when symptoms are complex or severe, or when the patient does not respond adequately to initial management in primary care. Referral is appropriate to rheumatologists, pain specialists, or other relevant secondary care clinicians for further evaluation and management, especially if the diagnosis is unclear or if there are significant impacts on quality of life and function. Specialist referral may also be warranted if there is suspicion of overlapping conditions or comorbidities that require specialist input. Fibromyalgia is classified as a chronic primary pain syndrome, and its diagnosis is clinical, often requiring exclusion of other conditions; thus, specialist assessment can aid in confirming diagnosis and tailoring management plans. Early referral should be considered if symptoms are severe, persistent beyond initial treatment attempts, or if the patient requires multidisciplinary input including pain management services or psychological support NICE NG193,NICE CKS. Literature supports that fibromyalgia diagnosis relies on clinical criteria and specialist evaluation can help differentiate it from other causes of widespread pain and fatigue, ensuring appropriate treatment Häuser & Wolfe 2012.