Who manages fibromyalgia?

I'm sorry if this has been discussed elsewhere, but in y'alls practice setting, who manages fibromyalgia? I'm starting to get more and more of these patients with diffuse muscle and joint pain, especially now that I just started seeing medicaid, yay. Typically I will refer to PT and a pain psych consult for cbt (which >50% never go to, and I'm in a small city with no good psych so refer outside), maybe start gabapentin/lyrica/cymbalta. There is no rheum in my town. I'll order the basic... Who manages fibromyalgia?
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