Fibromyalgia: Advances in pathophysiology, diagnostic biomarkers, genetic insights, multisystemic involvement, and treatment updates and multidisciplinary interventions.

Abstract

Background: This systematic review examines the pathophysiology, biomarkers, genetic insights, and treatment strategies for fibromyalgia, highlighting central sensitization, neuroinflammation, comorbidities, and the effectiveness of multidisciplinary interventions, including pharmacological and non-pharmacological therapies, to improve patient outcomes and quality of life.

Objectives: This study aims to explore the pathophysiology, diagnostic biomarkers, genetic insights, and multisystemic involvement in fibromyalgia. It also evaluates the effectiveness of pharmacological and non-pharmacological treatments in improving pain, fatigue, sleep quality, and overall quality of life.

Methodology: A systematic review was conducted on fibromyalgia from 2020 to 2025, focusing on pathophysiology, biomarkers, genetic insights, and treatment interventions. Studies were selected from PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar based on PICO criteria. Data on mechanisms, biomarkers, genetic factors, comorbidities, treatments, and outcomes were extracted. Risk of bias was assessed using appropriate tools for RCTs and non-RCTs. A total of 34 studies were included in the final review.

Results: The systematic review reveals significant improvements in fibromyalgia patients across various treatment modalities. Pain, sensitization, and sleep quality showed greater improvements using Myofascial Techniques (MTA). Pain alleviation, improved emotional health, and enhanced functional capabilities were noted from CES, S-ketamine, resistance exercise, and therapy dog treatments. Mental and general fatigue was markedly reduced in the FIBROOut group, showing greater levels of both fatigue and overall fatigue, while exercise alleviated fatigue. Sleep quality improvement was noted for all groups, though MTA and CES showed the most drastic changes with PSQI scores going from 15.5 ± 3.7 to 12.2 ± 4.8. Changes in biomarkers were also noted, confirming the usefulness of these methods. In general, multidisciplinary methods provide holistic management of pain, fatigue, and sleep disturbances in patients with fibromyalgia.

Conclusion: In conclusion, this review underscores the evolving knowledge on FM pathophysiology, and its relevant biomarkers and genetics, alongside treatment regimens. It highlights the need of tailored multidisciplinary strategies to address complexity of the syndrome.