One initial comment. All of these FM points below are worthy of a 2030 emerging medicine physician, and we are trying to be mindful of these routinely.
Yet we also find other things that are not given merit.
Iannuccelli and co-authors list some focus areas and we want to simplify the last few years of research where possible.
Terse definition: Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, high prevalence, and a significant impact on quality of life, relationships, and work.
Cause and Treatment? Despite extensive research, its pathogenesis and treatment remain only partially understood….
Cause Focuses:
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and….
Sympathetic nervous system dysregulation has been linked to chronic stress responses
Neuroinflammation, neuroimaging and preclinical studies confirm altered pain and stress processing.
Low-grade inflammation
Metabolic disturbances, including cytokine (inflammation and anti-inflammation chemical) imbalance (with increased adipose tissue infiltration), 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.
Studies have explored under-recognised aspects of FM, such as sexual and cognitive dysfunction… [and] environmental exposures
There is an increased realization that this harms relationships, including family relationships.
FM and long COVID has ignited discussion about potential shared mechanisms.
Residual chronic pain in inflammatory diseases remains insufficiently addressed.
Therapeutically, non-pharmacological strategies, particularly physical activity and psychosocial interventions, remain fundamental.
The Future?
Non-invasive neuromodulation
Psychedelic therapies
Technologies like virtual reality
Artificial intelligence is improving treatment, patient care, and research.
All these short comments show again that FM has many factors so care mult be taolired and usually include more than one healer.
Iannuccelli C, Favretti M, Dolcini G, Di Carlo M, Pellegrino G, Bazzichi L, Atzeni F, Lucini D, Varassi G, Leoni MLG, Fornasari DMM, Conti F, Salaffi F, Sarzi-Puttini P, Di Franco M. Fibromyalgia: one year in review 2025. Clin Exp Rheumatol. 2025 Jun;43(6):957-969. doi: 10.55563/clinexprheumatol/buhd2z. Epub 2025 Jun 3. PMID: 40470564.