Diagnosis: American college of rheumatology criteria - Widespread pain for more than 3 months (pain left and right body, above and below waist, axial skeleton pain) Trigger point tenderness (more than 11 out of 18 trigger points): trigger points \u2013 occiput (bilateral, suboccipital), low cervical (bilateral C5-7), trapezius (bilateral, midline upper), supraspinatus (bilateral, above scapula spine medial border), second rib (bilateral, 2nd chostochondral junctions), lateral epicondyle (bilateral), gluteal (bilateral, upper outer quadrant), greater trochanter (bilateral, posterior to trochanteric process), knee (bilateral, medial fat pad proximal to joint line). Fatigue \u2013 very common and disabling. May have some emotional\/ psychological trauma. Vegetative\/ functional disorders - non restorative sleep, depression\/ anxiety. Differential Diagnosis: SLE (systemic lupus erythematosus), polymyositis\/ dermatomyositis, PMR (polymyalgia rheumatica) , Carcinoma. Investigations needed: FBC, ESR, ANA (DsDNA, ENA- anti centromere\/ antiscl70), Immunoglobulins, Rheumatoid factor, CK, thyroid function tests. Management: Multidisciplinary\/ inter-professional - Central sensitisation, cognitive beliefs.Predictors of chronicity \u2013 previous pain, trigger points positive, distress, somatisation, fatigue, non restorative sleep, increased age, family history of chronic pain, low socioeconomic status. Also obesity, smoking, hypermobility and sedendary lifestyle.Pharmacological \u2013 Analgesia \u2013 nocioceptive pain \u2013 often normal analgesia does not help.Tricyclics (amitriptyline) or SSRI\u2019s or gabapentin\/ pregabalin.Non pharmacological \u2013 Physical exercise \u2013 graduated exercise programme reduces pain\/ increases function, improves sleep pattern, reduces fatigue\/ low mood.CBT (cognitive behavioural therapy) \u2013 active self management helps.Acupuncture \u2013 not enough evidence.Good predictors of prognosis \u2013 very distressed patients with significant deleterious effects on activities of daily living ( especially with CBT therapy). Short history of disease. Treatment started ASAP.