Towards Restoring Dopaminergic Balance in Fibromyalgia: The Untapped Potential of Nonpharmacological Interventions.

Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain, cognitive dysfunction, and mood disturbances. Growing evidence suggests that dopaminergic dysregulation may play a role in the pathophysiology of FM, linking reduced dopamine function to altered pain perception, anhedonia, fatigue, and impaired cognition. While pharmacological treatments-such as duloxetine, milnacipran, and pregabalin-may influence dopamine only indirectly, dopaminergic agonists like pramipexole have shown partial efficacy. Nonpharmacological interventions, including exercise, mindfulness, cognitive behavioral therapy (CBT), and noninvasive brain stimulation (NIBS), consistently improve symptoms, but their potential impact on dopamine pathways remains largely unexplored. This narrative-short review highlights a critical knowledge gap regarding dopaminergic modulation by nonpharmacological strategies and proposes a paradigm shift to be tested in future FM research. Future longitudinal, multimodal studies integrating neuroimaging, dopaminergic biomarkers, and clinical outcomes are required to test whether combined interventions exert synergistic effects on dopamine circuits. The validation of dopaminergic biomarkers to stratify patients according to their individual neurobiological profiles represents a critical step toward transitioning from a 'one-size-fits-all' approach to a precision medicine paradigm, enabling the development of tailored interventions aimed at restoring dopaminergic balance and, ultimately, improving pain, mood, cognition, and quality of life in FM patients.