Fibromyalgia: one year in review 2025.

Fibromyalgia is a chronic pain syndrome whose causes and treatments remain only partly understood. In 2024, research links it to dysregulation of stress-response systems, low-grade inflammation, metabolic disturbances, altered gut microbiota, and brain changes visible on MRI. Multi-omics approaches show promise for diagnostic biomarkers, and mitochondrial dysfunction appears to correlate with symptom severity. Clinically, under-recognized aspects include sexual and cognitive dysfunction, gender roles, environmental exposures, and impact on relationships. Shared mechanisms with long COVID are under discussion, while residual pain in inflammatory diseases remains inadequately addressed. Non-pharmacological strategies like physical activity and psychosocial interventions remain fundamental; emerging therapies include non-invasive neuromodulation, psychedelics, virtual reality, and artificial intelligence.

Study at a glance

Abstract

Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, high prevalence, and a significant impact on quality of life. Despite extensive research, its pathogenesis and treatment remain only partially understood, driving continued investigation throughout 2024. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system has been linked to chronic stress responses and neuroinflammation, with neuroimaging and preclinical studies confirming altered pain and stress processing. Low-grade inflammation and metabolic disturbances, including cytokine imbalance and increased adipose tissue infiltration, further exacerbate symptoms. Alterations in the gut microbiota contribute to immune and emotional dysregulation. MRI studies continue to reveal brain changes that differentiate FM from other chronic pain disorders. Multi-omics approaches, including transcriptomic and metabolomic analyses, show promise as diagnostic biomarkers. Mitochondrial dysfunction also emerges as a key factor, since impaired energy metabolism seems to correlate with symptom severity. From a clinical perspective, recent studies have explored under-recognised aspects of FM, such as sexual and cognitive dysfunction, the role of gender, environmental exposures, and the disease's impact on relationships and family life. The differential diagnosis of FM and long COVID has ignited discussion about potential shared mechanisms. Conversely, residual pain in inflammatory diseases remains insufficiently addressed. Therapeutically, non-pharmacological strategies, particularly physical activity and psychosocial interventions, remain fundamental. Emerging areas such as non-invasive neuromodulation, psychedelic therapies, and the integration of technologies like virtual reality and artificial intelligence are opening new frontiers in treatment, patient care, and research. These advances underscore the multifactorial nature of FM and the need for personalised, interdisciplinary approaches.