Therapeutic advances in fibromyalgia: one year in review 2026.

Fibromyalgia (FM) is a chronic nociplastic pain syndrome characterised by widespread pain, fatigue, sleep disturbances and cognitive impairment, with a significant impact on health-related quality of life (HRQoL). Despite the availability of several therapeutic options, management remains challenging and often requires a personalised and multidimensional approach.Over the past year, growing attention has been directed toward both emerging pharmacological strategies and innovative non-pharmacological interventions. Among pharmacological treatments, low-dose naltrexone (LDN) continues to show potential benefits in modulating neuroinflammation and central sensitisation. Cannabinoids and other neuromodulatory agents have also been investigated, with preliminary evidence suggesting a role in symptom control. In addition, novel approaches involving serotonergic modulation, including psychedelic compounds such as psilocybin, are being explored in early-phase studies.Intravenous lidocaine remains a potential option in selected refractory patients, although recent evidence has not substantially expanded its clinical role. Similarly, interest in nutraceuticals and antioxidant compounds is increasing, particularly in relation to mitochondrial function and oxidative stress.Non-pharmacological interventions remain a cornerstone of FM management. Recent studies highlight the importance of structured physical activity, including supervised exercise programs and digitally supported rehabilitation. Emerging approaches such as neuromodulation techniques, including non-invasive brain stimulation and vagal nerve stimulation, are gaining attention. Complementary and body-oriented interventions are also being explored for their potential impact on pain perception and emotional well-being.Overall, current evidence supports a biopsychosocial and multimodal approach, integrating pharmacological and non-pharmacological strategies tailored to individual patient profiles. Future research should focus on better phenotyping of patients and on identifying predictors of treatment response to optimise personalised management.