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Fibromyalgia in 2025

Progress in mechanisms and therapy for fibromyalgia

Nature Reviews Rheumatology volume 22, pages 84–85 (2026)Cite this article

Subjects

Fibromyalgia remains a challenge for researchers and clinicians. Three studies published in 2025 shed light on mechanisms and management by implicating gut microbiota in symptom perpetuation, demonstrating the potential of home-based neuromodulation, and examining the uncertain role of low-dose naltrexone.

Key advances

  • Faecal microbiota transplantation from patients with fibromyalgia induced pain and immune activation in germ-free mice, highlighting the gut–immune–brain axis as a potential therapeutic target3.

  • Home-based transcranial direct current stimulation combined with exercise improved pain and disability in fibromyalgia, with effects persisting for 4 months, supporting neuromodulation as a non-invasive treatment option4.

  • Low-dose naltrexone showed limited efficacy and no clear mechanistic correlation in fibromyalgia, emphasizing the need for rigorous trials to define its role in nociplastic pain management5.

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Author information

Authors and Affiliations

  1. Department of Anesthesia and Pain Management, Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada

    Hance Clarke

  2. Transitional Pain Service, University of Toronto, Toronto, Ontario, Canada

    Hance Clarke

  3. Department of Rheumatology, McGill University, Montreal, Quebec, Canada

    Mary-Ann Fitzcharles

  4. Alan Edwards Pain Management Unit, McGill University, Montreal, Quebec, Canada

    Mary-Ann Fitzcharles

Authors
  1. Hance Clarke
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  2. Mary-Ann Fitzcharles
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Corresponding author

Correspondence to Mary-Ann Fitzcharles.

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Competing interests

H.C. is the president of the Canadian Pain Society. M.-A.F. declares no competing interests.

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Clarke, H., Fitzcharles, MA. Progress in mechanisms and therapy for fibromyalgia. Nat Rev Rheumatol 22, 84–85 (2026). https://doi.org/10.1038/s41584-025-01344-4

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