From misdiagnosis to recovery: An integrative, deprescribing-led approach to fibromyalgia presenting as chronic widespread pain in an older adult

Explore (NY). 2026 Feb 13;22(3):103344. doi: 10.1016/j.explore.2026.103344. Online ahead of print.

ABSTRACT

BACKGROUND: Fibromyalgia in older adults is frequently underrecognized or misdiagnosed because of overlapping symptoms with affective disorders, neurodegenerative disease, and adverse drug reactions related to polypharmacy. These factors may obscure diagnosis and contribute to persistent symptoms and functional decline.

CASE PRESENTATION: We describe an older woman who presented with chronic widespread pain, fatigue, sleep disturbance, and low mood in the context of multimorbidity and extensive pharmacotherapy. She was initially treated for depression, during which her symptoms worsened alongside declining renal function. Following systematic clinical reassessment and medication review, a diagnosis of fibromyalgia was established according to the 2016 American College of Rheumatology criteria. A stepwise management strategy was implemented, beginning with deliberate deprescribing and symptom reassessment, followed by a staged integrative approach incorporating individualized traditional Chinese medicine-based herbal therapy to support symptom modulation and functional recovery.

OUTCOMES: Over a six-month follow-up period, the patient demonstrated gradual improvement in pain severity, sleep quality, physical function, and overall well-being, without recurrence of medication-related adverse effects. Symptom improvement occurred in parallel with medication rationalization and stabilization of renal function.

CONCLUSION: This case highlights fibromyalgia as an important diagnostic consideration in older adults presenting with chronic widespread pain and polypharmacy. Deprescribing may function as both a diagnostic and therapeutic intervention in such contexts. Integrative, patient-centered care may provide supportive benefit following medication rationalization. Although causal inferences cannot be drawn from a single case, this report underscores the value of reflective clinical reasoning and individualized integrative strategies in the management of fibromyalgia in complex geriatric settings.

PMID:41722280 | DOI:10.1016/j.explore.2026.103344