The Gür fibromyalgia model: a clinically operational framework for phenotype-informed, sequence-sensitive multimodal care.

Abstract

Fibromyalgia affects approximately 2%-4% of adults and many patients obtain less than clinically meaningful benefit from any single pharmacological treatment, underscoring the need for a practical method of prioritizing multimodal care. This purposive narrative, hypothesis-generating review introduces the Gür Fibromyalgia Model (GFM), an expert-derived and currently unvalidated framework that organizes fibromyalgia around five interacting domains: central pain amplification, sleep dysregulation, load imbalance, peripheral drivers, and regulation deficit. Its therapeutic value lies not in introducing novel interventions but in sequencing familiar interventions with greater clinical deliberation. The model uses domain-weighted bedside assessment, phenotype-informed entry-point selection, and iterative reassessment to move from generic multimodal care toward deliberate, sequence-sensitive multimodal care. Tables 5, 6 provide an operationalization map and a provisional 0-3 research checklist with a defined recall window and decision rules. The GFM is not a replacement for diagnostic, nociplastic, biopsychosocial, clustering, or guideline frameworks; it is a testable sequencing hypothesis intended to determine whether closer alignment between dominant burden and the initial therapeutic lever improves adherence, tolerance, function, and early clinical trajectory. To our knowledge, the GFM is the first framework to operationalize domain-weighted, sequence-sensitive treatment entry-point selection as an explicitly testable clinical hypothesis within the constraints of standard fibromyalgia consultation.