Fibromyalgia and metabolic syndrome: prevalence, potential shared pathophysiological mechanisms and...

Fibromyalgia (FM) is a chronic pain syndrome defined by widespread musculoskeletal pain, fatigue and sleep disturbances, frequently accompanied by metabolic disturbances. Among these, metabolic syndrome (MetS), a cluster of abdominal obesity, hypertension, dyslipidaemia and impaired glucose regulation, stands out because of its strong association with cardiovascular disease and type 2 diabetes. Recent studies suggest that MetS and its individual components, particularly obesity, are highly prevalent in FM populations, raising important clinical and pathophysiological questions.Both FM and MetS are associated with chronic low-grade inflammation, autonomic nervous system dysfunction, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Moreover, environmental factors, particularly early-life stress, may increase vulnerability by triggering persistent neuroendocrine and immune alterations. These overlapping pathways not only predispose to comorbidity but also contribute to increased symptom burden and therapeutic complexity. Systematic screening for MetS in patients with FM may improve cardiovascular risk stratification and inform more comprehensive treatment strategies. This narrative review summarises current evidence on the comorbidity of FM with MetS and its individual components, highlighting their shared pathophysiology. It also explores the therapeutic potential of non-pharmacological strategies, including structured exercise, dietary interventions, and microbiome-targeted approaches, that address common underlying mechanisms and hold promise for improving long-term outcomes.