Fibromyalgia (already diagnosed in person), online

Common symptoms

• Long-lasting pain all over the body
• Tiredness, poor sleep, and trouble thinking clearly
• Pain that comes and goes, with flares and good weeks
• Your usual fibromyalgia pain, not a new kind and not in a new place

May fit online care

• Adults 18 and older
• You are 18 to 64
• A doctor, nurse practitioner, or physician assistant told you in person that you have fibromyalgia
• That clinician saw you in person for it in the last 12 months
• It is your usual fibromyalgia pain, not a new kind, not in a new place, and not much worse
• You have no swollen joint, no joint that changed shape, no weight loss without trying, and no night sweats
• No test or specialist is still waiting for you, and an inflammatory arthritis is not your main problem
• You take no opioid, and no gabapentin, pregabalin, or benzodiazepine for this pain
• You are not pregnant, could not be pregnant, and are not trying to get pregnant
• You do not feel so down that you cannot do your usual things, and you have no thoughts of harming yourself
• For a medicine, you ask for one, and exercise, CBT, or sleep care did not help enough
• For duloxetine, you are 25 to 64. If you are 18 to 24, you get the written plan without duloxetine
• For duloxetine, you are not breastfeeding, and every safety screen is clear
• You have none of the warning signs below

Look for another care setting

• Chest pain, trouble breathing, or fainting (call 911 or go to the ER now).
• Weakness on one side of your body, a drooping face, trouble speaking, or sudden loss of vision (call 911 or go to the ER now).
• An arm or leg that is newly weak, or weakness that is getting worse (call 911 or go to the ER now).
• New loss of control of your pee or poo, new trouble starting to pee, or not being able to pee (call 911 or go to the ER now).
• A joint that is hot and swollen, or red and swollen (call 911 or go to the ER now).
• Pain from a serious accident, like a car crash (call 911 or go to the ER now).
• A seizure (call 911 or go to the ER now). If you take duloxetine, stop the medicine.
• Vomiting blood, or bloody, black, or tarry poo (call 911 or go to the ER now). If you take duloxetine, stop the medicine.
• If you take duloxetine: in the last 24 hours you took more duloxetine than your plan says, even a little more. Call 911 or go to the ER now.
• If you take duloxetine: trouble breathing or wheezing, hives, swelling of your face, lips, tongue, or throat, blisters, a peeling rash, sores in your mouth, or feeling faint. Stop the medicine. Call 911 or go to the ER now.
• If you take duloxetine: you feel very agitated, you see or hear things that are not there, you are confused, your heart races, you sweat a lot with a fever, you shake, or your muscles twitch or feel stiff. Stop the medicine. Call 911 or go to the ER now.
• If you take duloxetine: eye pain, a change in your vision, or swelling or redness in or around your eye. Stop the medicine. Call 911 or go to the ER now.
• If you are having thoughts of harming yourself or someone else, call or text 988 (Suicide and Crisis Lifeline) or go to the nearest emergency department immediately. After you start duloxetine, do the same if you are acting on dangerous impulses, and stop the medicine.
• In the last 4 weeks, or since your last visit with us, you had chest pain, trouble breathing, fainting, weakness on one side of your body, a drooping face, trouble speaking, sudden loss of vision, a newly weak arm or leg, new loss of control of your pee or poo, new trouble starting to pee, not being able to pee, a seizure, or vomiting blood or bloody, black, or tarry poo. It has stopped, and no clinician has checked it since. If it was a seizure or bleeding and you take duloxetine, stop the medicine (go to the ER today).
• If you take duloxetine and, since your last visit, one of the signs in the duloxetine 911 list above happened and it has stopped. Stop the medicine (go to the ER today).
• A fever of 100.4°F (38°C) or higher, chills, or feeling very sick in the last 24 hours (go to the ER or urgent care today).
• New numbness or tingling in an arm, a leg, or your face, or numbness that is spreading (go to the ER or urgent care today).
• You fell, got hit, or had an accident in the last 4 weeks that left new pain, swelling, or bruising (go to the ER or urgent care today).
• After you start duloxetine: you fell and were hurt in the last 24 hours (go to the ER or urgent care today).
• After you start duloxetine, at any time since your last visit, even if it went away: your skin or eyes turn yellow, your pee is dark, you itch, or you have pain in the upper right belly. Stop the medicine (go to the ER or urgent care today).
• After you start duloxetine, at any time since your last visit, even if it went away: bleeding that will not stop, large bruises you cannot explain, or a bad headache with feeling weak, unsteady, or unable to think clearly. Stop the medicine (go to the ER or urgent care today).
• After you start duloxetine, at any time since your last visit, even if it went away: any new skin rash. Stop the medicine (see a doctor in person today).
• After you start duloxetine, at any time since your last visit, even if it went away: new or worse sadness, worry, or panic attacks, you feel very agitated or restless, you have new anger or irritability, a burst of high energy with little need for sleep, or racing thoughts. Stop the medicine (see a doctor in person today).
• After you start duloxetine, you had thoughts of ending your life or harming yourself since you started, even if they passed. Stop the medicine (see a doctor in person today).
• Your pain is different, in a new place, or worse than your usual fibromyalgia pain (see a doctor in person within 7 days).
• A joint is swollen, or has changed shape (see a doctor in person within 7 days).
• You lost weight without trying, or you have night sweats (see a doctor in person within 7 days).
• You feel so down or hopeless most days that you cannot do your usual things (see a doctor in person within 7 days).
• You take an MAOI (phenelzine, tranylcypromine, selegiline, rasagiline, isocarboxazid, or a brand such as Marplan, Nardil, Parnate, Azilect, or the Emsam patch) now or in the last 14 days. Or you take linezolid (Zyvox) or methylene blue now or in the last 24 hours. Or a doctor says you need one of these. Stop duloxetine now, if you take it from us. The doctor who prescribes that medicine decides what to do. Tell that doctor that you take duloxetine. We send no plan to stop slowly. We send no more duloxetine. If a list above also fits you, follow that list and stop duloxetine now (see your own doctor).
• No doctor, nurse practitioner, or physician assistant told you in person that you have fibromyalgia, or none saw you in person for it in the last 12 months (see your own doctor).
• The doctor said you need tests or a specialist that you have not had yet (see your own doctor).
• You have rheumatoid arthritis, lupus, ankylosing spondylitis, psoriatic arthritis, or another arthritis caused by inflammation (see your own doctor).
• You are under 18, or 65 or older (see your own doctor).
• You take any opioid for any reason, like tramadol, methadone, or buprenorphine (see the doctor who prescribes it).
• You take gabapentin (Neurontin), pregabalin (Lyrica), or a benzodiazepine for this pain now (see the doctor who prescribes it).
• You want a prescription for an opioid, tramadol, gabapentin, pregabalin, or a muscle relaxer (see your own doctor).
• You are not clearly better after 12 weeks of your plan, or you have taken duloxetine for about 12 weeks. Your own doctor takes over then (see your own doctor).
• When you ask for a medicine or at a check-in, you have no blood pressure reading from the last 7 days, or your reading is 140/90 or higher (see your own doctor).
• Pregnant, might be, or trying to get pregnant (see your pregnancy doctor or midwife).
• If more than one fits, follow the first one.