Advancing insights into fibromyalgia: an updated review of diagnosis and differential diagnosis
Open accessAbstract
INTRODUCTION: Despite advances in understanding nociplastic pain and central sensitization, fibromyalgia remains a challenging clinical diagnosis due to the absence of specific biomarkers, extensive symptom overlap with other conditions, and persistent misconceptions about its pathophysiology. AREAS COVERED: This narrative review covers the evolution of the diagnostic criteria, the clinical presentation, the red flags suggesting alternative diagnoses, and a practical diagnostic approach toward fibromyalgia. Attention is given to its differential diagnosis with rheumatological, neurological, endocrine, sleep, and psychiatric conditions as well as other overlap syndromes, along with emerging tools including quantitative sensory testing, small fiber pathology, neuroimaging, and digital phenotyping. Evidence was identified through a search of PubMed and Web of Science (April to May 2026) for 'fibromyalgia' combined with key terms, supplemented by hand-searching reference lists and recent systematic reviews. EXPERT OPINION: Fibromyalgia should be approached not as a diagnosis of exclusion but as a recognizable nociplastic pain syndrome requiring mechanism-informed evaluation. In practice, this means applying the American College of Rheumatology 2010/2016 criteria positively, limiting work-up to a five-test panel (complete blood count, erythrocyte sedimentation rate, C-reactive protein, thyroid-stimulating hormone, and creatine kinase if weakness is present) unless red flags dictate otherwise, and only when diagnostic uncertainty, red flags, or overlapping inflammatory disease persist.
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Cupit, C., Finlay, T. M. D., & Pope, C. J. (2025) · Sociology of Health & Illness · doi:10.1111/1467-9566.70008 · Cited by 5 · see citing works
Prevalence of chronic pain in the general population: A systematic review and meta-analysis
Saxena, A. K., Singh, N. C., Chilkoti, G. T., Gulabani, M., & Malhotra, R. K. (2026) · The Indian Journal of Medical Research · doi:10.25259/ijmr_1935_2025 · Cited by 4 · see citing works
Inflammation and pain as interconnected targets in axial spondyloarthritis
Baraliakos, X., Navarro‐Compán, V., Ziadé, N., & Poddubnyy, D. (2026) · Nature Reviews Rheumatology · doi:10.1038/s41584-025-01348-0 · Cited by 4 · see citing works
Explaining a diagnosis of fibromyalgia in primary care: a scoping review
McConnell, K., Heron, N., & Hart, N. D. (2023) · BJGP Open · doi:10.3399/bjgpo.2023.0033 · Cited by 4 · see citing works
Lum, G., Das, A., Ahmed, S., Tahir, S. H., Hutchins, D., & Tahir, H. (2025) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2025.2604681 · Cited by 3 · see citing works
Lin, L., Li, Y., Ji, F., Lin, J., Zhu, M., Liang, D., Cao, M., Fu, G., & Fu, Y. (2026) · PLoS Genetics · doi:10.1371/journal.pgen.1012034 · Cited by 3 · see citing works
Moving Toward Objective Diagnosis in Fibromyalgia: Emerging Biomarkers and Digital Phenotyping Tools
García‐Domínguez, M. (2026) · Biomedicines · doi:10.3390/biomedicines14020440 · Cited by 3 · see citing works
Validity and reliability of the perseverative thinking questionnaire in patients with fibromyalgia
Benlidayı, İ. C., Ornek, C., Deniz, V., & Sarıyıldız, A. (2025) · Clinical Rheumatology · doi:10.1007/s10067-025-07851-9 · Cited by 2 · see citing works
Vázquez-González, G., Allande-Cussó, R., Gómez-Salgado, J., Yıldırım, M., Fagundo-Rivera, J., Climent-Rodríguez, J.-A., & Navarro-Abal, Y. (2025) · Atención Primaria · doi:10.1016/j.aprim.2025.103251 · Cited by 2 · see citing works
Regarding the pain of men: characteristics of fibromyalgia in male patients
Bannon, L., Shlezinger, O., Berman, M., et al. (2025) · Clinical and Experimental Rheumatology · doi:10.55563/clinexprheumatol/s5e2km · Cited by 2 · see citing works
Optimising fibromyalgia criteria: evidence from the UK Biobank
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Fibromyalgia: the Italian survey by the ministry of health
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Fibromyalgia in men: beyond invisibility—a biopsychosocial and clinical perspective in rheumatology
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Living with fibromyalgia: Scoping review of patients' lived experience
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Predicting Nonresponse to Multicomponent Treatment in Fibromyalgia
López-García, R., Serrat, M., Sanabria‐Mazo, J. P., Pérez‐Aranda, A., Almirall, M., Delgadillo, J., Espelt, A., Luciano, J. V., Nieto, R., & Feliu‐Soler, A. (2026) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001367 · Cited by 1 · see citing works
Flagged first, then by citations
- Authors
- Segura-Jiménez, V.
- Affiliations
- Hospital Universitario Virgen de las Nieves
- Venue
- Expert Review of Neurotherapeutics
- Publisher
- Informa UK Limited
- Published
- 2026-09-16
- Volume
- 26
- Issue
- 10
- Pages
- 985-1003
- ISSN
- 1473-7175 (ISSN-L)
- 1744-8360
- OpenAlex
- W7213451865
- Semantic Scholar
- cb276aed71234e7667e1a5bda11ea30f2ddcdaf7
- Cited by
- 0
- References
- 108
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Expert Review of Neurotherapeutics (publishedVersion)
- PubMed (publishedVersion)
- Figshare (cc-by)
- Funders
- Conserjería de Salud y Consumo, Junta de Andalucía (C1-0005–2025)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- fibromyalgia, diagnosis, differential diagnosis, nociplastic pain, central sensitization, diagnostic criteria, red flags, overlap syndrome, quantitative sensory testing, neuroimaging, digital phenotyping, biomarkers, inflammatory diseases
- MeSH terms
- Nociplastic Pain, Diagnosis, Differential, Fibromyalgia, Humans
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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