Fibromyalgia: diagnosis and management

Fibromyalgia is characterized by chronic widespread musculoskeletal pain and accompanied by various somatic and psychological symptoms such as sleep problems, fatigue, cognitive dysfunction, depression and anxiety. Fibromyalgia, as a representative condition of nociplastic pain and classified as chronic primary pain, is recognized as an independent disorder. However, its pathogenesis and treatment remain incompletely established to date. The pathogenesis of fibromyalgia involves a complex interplay of factors, including neurotransmitter imbalances, dysregulation of the neuro-endocrine-hormonal axis mediated by the autonomic nervous system gut microbiota imbalances, mitochondrial dysfunction, impaired antioxidant capacity, as well as genetic and psycho-social factors. The management of fibromyalgia requires an integrated approach combining pharmacological and non-pharmacological therapies tailored to individual patients. Pharmacological treatment includes FDA-approved medications such as pregabalin, duloxetine, and milnacipran, as well as the use of tricyclic antidepressants, gabapentin, and tramadol. Generally, using more than one medication tailored to symptoms is effective, and a multidisciplinary approach that prioritizes non-pharmacological treatments is necessary. Nonsteroidal anti-inflammatory drugs and strong opioids have not demonstrated benefits for fibromyalgia and have significant limitations. Lifestyle modification, such as low-intensity exercise, mind-body relaxation, an anti-inflammatory and antioxidant diet and maintaining a nutritional status that supports gut microbiota balance, are key factors in fibromyalgia management. This study aims to review the latest insights on fibromyalgia and enhance the understanding of this condition to ultimately aid in patient treatment.