Review
Fibromyalgia: one year in review 2025
C. Iannuccelli1, M. Favretti2, G. Dolcini3, M. Di Carlo4, G. Pellegrino5, L. Bazzichi6, F. Atzeni7, D. Lucini8, G. Varassi9, M.L.G. Leoni10, D.M.M. Fornasari11, F. Conti12, F. Salaffi13, P. Sarzi Puttini14, M. Di Franco15
- Rheumatology Unit, AOU Policlinico Umberto I, Sapienza University of Rome, Italy.
- Department of Molecular Medicine, Sapienza University of Rome, Italy. martina.favretti@uniroma1.it
- Department of Molecular Medicine, Sapienza University of Rome, Italy.
- Rheumatology Unit, Università Politecnica delle Marche, Carlo Urbani Hospital, Jesi (Ancona), Italy.
- IRCCS Ospedale Galeazzi Sant’Ambrogio, Milan; and Department of Biomedical and Clinical Sciences, University of Milan, Italy.
- IRCCS Ospedale Galeazzi Sant’Ambrogio, Milan, Italy.
- Rheumatology Unit, Department of Internal and Experimental Medicine, University of Messina, Italy.
- BIOMETRA Department, University of Milan; and IRCCS Istituto Auxologico Italiano, Exercise Medicine Unit, Milan, Italy.
- Paolo Procacci Foundation, Rome, Italy.
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy.
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy.
- Rheumatology Unit, Department of Clinical Internal, Anaesthesiologic and Cardiovascolar Sciences, Sapienza University of Rome, Italy.
- Rheumatology Unit, Università Politecnica delle Marche, Carlo Urbani Hospital, Jesi (Ancona), Italy.
- IRCCS Ospedale Galeazzi Sant’Ambrogio, Milan; and Department of Biomedical and Clinical Sciences, University of Milan, Italy.
- Rheumatology Unit, Department of Clinical Internal, Anaesthesiologic and Cardiovascolar Sciences, Sapienza University of Rome, Italy.
CER18882
Review
Free to view
(click on article PDF icon to read the article)
PMID: 40470564 [PubMed]
Received: 29/04/2025
Accepted : 06/05/2025
In Press: 03/06/2025
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.
