Fibromyalgia: Update on Pathogenesis and Management

Fibromyalgia (FM) is a complex disorder characterized by chronic widespread pain, fatigue, sleep disturbances, mood alterations, and cognitive impairment. This review aims to provide an updated understanding of pathophysiology and management, highlighting recent advances in both pharmacologic and non-pharmacologic treatment options. Multifactorial pathophysiology includes the central and peripheral nervous systems, psychosocial stressors, the hypothalamic–pituitary–adrenal axis, the autonomic nervous system, and the immune system. Obesity and obstructive sleep apnea are also significant contributors. Diagnosis is clinical and requires a systematic approach. Nonpharmacologic treatments, including education, psychotherapy, exercise, and sleep optimization, are first-line management. Pharmacotherapy is offered to patients who need additional symptom control, and evidence for the most promising options is discussed. The review underscores the importance of a multidisciplinary approach to improve quality of life and suggests potential future directions for FM management.Cite this article as: Wu E, Brener A, Hiser JKD, Hill DLK, Farmer JO. Fibromyalgia: Update on pathogenesis and management. Eur J Rheumatol. 2025, 12(4), 0032, doi:10.5152/ eurjrheum.2025.25032.