Goldenberg et al suggest that tramadol works via its serotonin and norepinephrine reuptake inhibition, rather than via its action as a weak opioid receptor agonist.A large study of US people with fibromyalgia found that between 2005 and 2007 37.4% were prescribed short-acting opioids and 8.3% were prescribed long-acting opioids, with around 10% of those prescribed short-acting opioids using tramadol; and a 2011 Canadian study of 457 people with FM found 32% used opioids and two-thirds of those used strong opioids. Topical treatment
Capsaicin has been suggested as a topical pain reliever. Preliminary results suggest that it may improve sleep quality and fatigue, but there are not enough studies to support this claim. Unapproved or unfounded
Sodium oxybate increases growth hormone production levels through increased slow-wave sleep patterns. However, this medication was not approved by the FDA for the indication for use in people with fibromyalgia due to the concern for abuse.The muscle relaxants cyclobenzaprine, carisoprodol with acetaminophen and caffeine, and tizanidine are sometimes used to treat fibromyalgia; however, as of 2015 they are not approved for this use in the United States. The use of NSAIDs is not recommended as first line therapy. Moreover, NSAIDs cannot be considered as useful in the management of fibromyalgia.Very low-quality evidence suggests quetiapine may be effective in fibromyalgia.No high-quality evidence exists that suggests synthetic THC (nabilone) helps with fibromyalgia. Others
A 2013 review found moderate-level evidence on the usage of acupuncture with electrical stimulation for improvement of the overall well-being.
Use of control points has been used to cast doubt on whether a person has fibromyalgia, and to claim the person is malingering. American College of Rheumatology 2010 provisional criteria
In 2010, the American College of Rheumatology approved provisional revised diagnostic criteria for fibromyalgia that eliminated the 1990 criterias reliance on tender point testing. The revised criteria used a widespread pain index (WPI) and symptom severity scale (SSS) in place of tender point testing under the 1990 criteria. The WPI counts up to 19 general body areas in which the person has experienced pain in the preceding week. The SSS rates the severity of the persons fatigue, unrefreshed waking, cognitive symptoms, and general somatic symptoms, each on a scale from 0 to 3, for a composite score ranging from 0 to 12. The revised criteria for diagnosis were:

WPI ≥ 7 and SSS ≥ 5 OR WPI 3–6 and SSS ≥ 9,
Symptoms have been present at a similar level for at least three months, and
No other diagnosable disorder otherwise explains the pain. : 607

American College of Rheumatology 2016 revisions
In 2016, the provisional criteria of the American College of Rheumatology from 2010 were revised. The new diagnosis required all of the following criteria:

"Generalized pain, defined as pain in at least 4 of 5 regions, is present." "Symptoms have been present at a similar level for at least 3 months." "Widespread pain index (WPI) ≥ 7 and symptom severity scale (SSS) score ≥ 5 OR WPI of 4–6 and SSS score ≥ 9."