Modern view on fibromyalgia through the concept of nociplastic pain: from mechanisms to treatment

Fibromyalgia is a chronic nociplastic pain syndrome associated not with tissue damage, but with altered central pain processing, sensitization, neurotransmitter imbalance, and neuroimmune mechanisms. The clinical presentation extends beyond widespread pain and includes fatigue, sleep disturbances, cognitive and affective symptoms, sensory hypersensitivity, and various somatic manifestations. The absence of specific laboratory or instrumental markers complicates diagnosis, which is based on clinical assessment and contemporary ACR/AAPT criteria. Management is based on a multimodal approach. Particular attention has been drawn to cyclobenzaprine, a drug with a multitarget mechanism of action affecting key neurotransmitter systems. Data from randomized controlled trials and meta-analyses demonstrate its ability to reduce pain, improve sleep, functioning, and overall patient well-being. It’s use is supported by EULAR recommendations and the expansion of FDA indications.

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