Fibromyalgia is a complex disorder characterized primarily by chronic widespread pain, fatigue and other physical and cognitive symptoms. Although it affects millions of people worldwide, the underlying biological mechanisms are not yet fully understood. Now, a study by the University of Barcelona suggests that neuroimmune alterations in the central nervous system may play a key role in the development and progression of this condition. The findings, based on a comprehensive review of recent research in this field, help move beyond the view of fibromyalgia as a purely subjective condition and may open up new avenues for the diagnosis and treatment of this disorder.
“These findings converge on brain networks involved in pain processing, emotional regulation, cognition and behaviour. Together, they contribute to advancing a more integrated and accurate understanding of the disorder, consistent with a biopsychosocial perspective on health, which views the condition as the result of the interaction between biological, psychological and social factors,” highlight Marçal Castán, from the Department of Clinical Psychology and Pyschobiology of the UB’s Faculty of Psychology and the Service of Psychological Care of the UB, and Adela Fusté, from the same Department and member of the Institute of Neurosciences at the UB (UBneuro). Both are authors of the article, published online in the journal Brain, Behavior, and Immunity.
In this regard, the researchers emphasize that, if the central nervous system and the immune system influence one another and work in an interconnected manner, factors such as sleep, stress, physical activity, lifestyle habits and psychological well-being should not be viewed “as complementary elements in the medical treatment of fibromyalgia, but as central aspects of its management.”
Biological clues to a complex disorder
The study has combined neuroimaging and gene expression studies, cerebrospinal fluid analysis and cellular studies – an approach that has made it possible to identify a consistent pattern of neuroimmune alterations, that is, changes in the way the nervous system and the immune system communicate and regulate each other.
Among the mechanisms identified, a possible activation of the brain’s immune cells—particularly microglia—stands out. Changes in the levels of cytokines and other immune molecules in the cerebrospinal fluid of patients with fibromyalgia have also been reported, as well as alterations in the expression of genes related to inflammatory processes. “Taken together, these findings suggest a pattern of neuroimmune dysregulation that goes beyond classic inflammation and involves both mechanisms that promote inflammation and alterations in the mechanisms that regulate it,” note Castán and Fusté.
Challenges in diagnosis and treatment
The study’s findings could steer research towards the development of more objective biomarkers which, in the future, may help to improve diagnosis — currently based on clinical criteria — or identify subgroups of patients with distinct biological profiles.
From a therapeutic perspective, these findings open the door to exploring interventions targeting the neuroimmune processes involved in pain, fatigue, mood and other symptoms, through both pharmacological strategies and a multidisciplinary approach. However, the authors emphasize that further studies — particularly longitudinal and translational ones — are needed to confirm the role of these processes and to understand how they evolve over time.