An aerobic exercise program is appropriate for this patient with fibromyalgia, which is characterized by chronic widespread pain, tenderness of skin and muscles to pressure, fatigue, sleep disturbance, and exercise intolerance. Nonpharmacologic therapy is the cornerstone of treatment and should be initiated in all affected patients. Regular aerobic exercise has been shown to be effective in this setting. Exercise regimens should be individualized and titrated up to 30 minutes most days of the week. Physical therapy may also be helpful initially to develop a stretching and progressive aerobic program. Cognitive behavioral therapy has been shown to be beneficial but is not always covered by insurance plans.

NSAIDs such as ibuprofen have not been shown to be particularly useful in fibromyalgia, and most patients have tried them before seeking medical care for their symptoms. Although possibly helpful when taken on an as-needed basis for other musculoskeletal pain, NSAIDs as a primary therapy for fibromyalgia would not be appropriate.

This patient also has hypothyroidism but has a normal thyroid-stimulating hormone level, indicating that she is being treated properly and does not need an increase of her levothyroxine dose.

Fibromyalgia may co-occur in patients with inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome, but this patient does not have any clinical signs or laboratory features that would suggest an inflammatory disease. Thus, an antinuclear antibody (ANA) panel would not be helpful, and a clinically insignificant low-level positive ANA may actually lead to further unnecessary testing and specialist referral.