Diffuse pain syndromes are common in older persons. Fibromyalgia and PMR are the most common but other inflammatory, endocrine and neoplastic diseases may cause diffuse pain as well. A thorough history and physical examination, screening laboratories and response to a trial of low-dose steroids may help to differentiate between syndromes. Fibromyalgia may be a secondary phenomenon associated with some of the other diffuse pain syndromes. This should be kept in mind if a patient fails to respond appropriately to treatments directed at a particular disease.