# Moving Toward Objective Diagnosis in Fibromyalgia: Emerging Biomarkers and Digital Phenotyping Tools

**Authors:** Mario García-Domínguez

PMC · DOI: 10.3390/biomedicines14020440 · Biomedicines · 2026-02-15

## TL;DR

This paper explores new biomarkers and digital tools that could help diagnose fibromyalgia more objectively, improving diagnosis and treatment.

## Contribution

The paper highlights novel biomarkers and digital phenotyping approaches for objective fibromyalgia diagnosis.

## Key findings

- Neuroimaging and inflammatory markers show promise as objective fibromyalgia indicators.
- Digital tools like wearables and machine learning can capture real-world symptom patterns.
- Combining biological and digital data may lead to more accurate fibromyalgia classification.

## Abstract

Fibromyalgia is a complex chronic pain condition characterized by pervasive pain, persistent fatigue, and cognitive disturbances. Despite advances in understanding its neurobiological mechanisms, diagnosis largely relies on subjective symptom assessment and exclusion criteria, contributing to underdiagnosis and treatment delays. Recent research has increasingly focused on identifying objective biomarkers and leveraging digital phenotyping to improve diagnostic precision. Promising biomarkers include neuroimaging indicators of altered pain processing, neuroinflammatory signatures in cerebrospinal fluid and blood, and dysregulated neuroendocrine and autonomic patterns. In addition, metabolomics and transcriptomics have revealed molecular profiles associated with fibromyalgia pathophysiology. Concurrently, digital health tools (e.g., wearable sensors, ecological momentary assessment, and machine learning-based symptom clustering) offer opportunities for continuous, real-world data collection and individualized disease characterization. This body of work suggests that integrating biological and digital metrics could enable a transition from subjective to objective data-driven fibromyalgia classification, facilitating earlier diagnosis and improved therapeutic outcomes.

## Linked entities

- **Diseases:** fibromyalgia (MONDO:0005546)

## Full-text entities

- **Genes:** TFAM (transcription factor A, mitochondrial) [NCBI Gene 7019] {aka MTDPS15, MTTF1, MTTFA, TCF6, TCF6L1, TCF6L2}, BDNF (brain derived neurotrophic factor) [NCBI Gene 627] {aka ANON2, BULN2}, ANXA1 (annexin A1) [NCBI Gene 301] {aka ANX1, LPC1}, PCSK1N (proprotein convertase subtilisin/kexin type 1 inhibitor) [NCBI Gene 27344] {aka BigLEN, PEN, PROSAAS, SAAS, SCG8, SgVIII}, CRH (corticotropin releasing hormone) [NCBI Gene 1392] {aka CRF, CRH1}, CXCL8 (C-X-C motif chemokine ligand 8) [NCBI Gene 3576] {aka GCP-1, GCP1, IL8, LECT, LUCT, LYNAP}, APOC3 (apolipoprotein C3) [NCBI Gene 345] {aka APOCIII, Apo-C3, ApoC-3}, COMT (catechol-O-methyltransferase) [NCBI Gene 1312] {aka HEL-S-98n}, NOS2 (nitric oxide synthase 2) [NCBI Gene 4843] {aka HEP-NOS, INOS, NOS, NOS2A}, S100A9 (S100 calcium binding protein A9) [NCBI Gene 6280] {aka 60B8AG, CAGB, CFAG, CGLB, L1AG, LIAG}, CCL11 (C-C motif chemokine ligand 11) [NCBI Gene 6356] {aka SCYA11}, NRF1 (nuclear respiratory factor 1) [NCBI Gene 4899] {aka ALPHA-PAL}, CCL5 (C-C motif chemokine ligand 5) [NCBI Gene 6352] {aka D17S136E, RANTES, SCYA5, SIS-delta, SISd, TCP228}, CXCL9 (C-X-C motif chemokine ligand 9) [NCBI Gene 4283] {aka CMK, Humig, MIG, SCYB9, crg-10}, NR3C1 (nuclear receptor subfamily 3 group C member 1) [NCBI Gene 2908] {aka GCCR, GCR, GCRST, GR, GRL}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, S100A8 (S100 calcium binding protein A8) [NCBI Gene 6279] {aka 60B8AG, CAGA, CFAG, CGLA, CP-10, L1Ag}, NQO1 (NAD(P)H quinone dehydrogenase 1) [NCBI Gene 1728] {aka DHQU, DIA4, DTD, NMOR1, NMORI, QR1}, IL10 (interleukin 10) [NCBI Gene 3586] {aka CSIF, GVHDS, IL-10, IL10A, TGIF}, ND4 (NADH dehydrogenase subunit 4) [NCBI Gene 4538] {aka MTND4}, TLR2 (toll like receptor 2) [NCBI Gene 7097] {aka CD282, TIL4}, CPT1A (carnitine palmitoyltransferase 1A) [NCBI Gene 1374] {aka CPT I, CPT1, CPT1-L, CPTI-L, L-CPT1}, TLR4 (toll like receptor 4) [NCBI Gene 7099] {aka ARMD10, CD284, TLR-4, TOLL}, IL1B (interleukin 1 beta) [NCBI Gene 3553] {aka IL-1, IL1-BETA, IL1F2, IL1beta}, CD163 (CD163 molecule) [NCBI Gene 9332] {aka M130, MM130, SCARI1}, NGF (nerve growth factor) [NCBI Gene 4803] {aka Beta-NGF, HSAN5, NGFB}, GABRB3 (gamma-aminobutyric acid type A receptor subunit beta3) [NCBI Gene 2562] {aka DEE43, ECA5, EIEE43}, CCL2 (C-C motif chemokine ligand 2) [NCBI Gene 6347] {aka GDCF-2, HC11, HSMCR30, MCAF, MCP-1, MCP1}, MYD88 (MYD88 innate immune signal transduction adaptor) [NCBI Gene 4615] {aka IMD68, MYD88D, WM1}, CCL17 (C-C motif chemokine ligand 17) [NCBI Gene 6361] {aka A-152E5.3, ABCD-2, SCYA17, TARC}, HMOX1 (heme oxygenase 1) [NCBI Gene 3162] {aka HMOX1D, HO-1, HSP32, bK286B10}, LOX (lysyl oxidase) [NCBI Gene 4015] {aka AAT10}, STAMBP (STAM binding protein) [NCBI Gene 10617] {aka AMSH, MICCAP}, SOCS3 (suppressor of cytokine signaling 3) [NCBI Gene 9021] {aka ATOD4, CIS3, Cish3, SOCS-3, SSI-3, SSI3}, TAC1 (tachykinin precursor 1) [NCBI Gene 6863] {aka Hs.2563, NK2, NKNA, NPK, TAC2}, IFNG (interferon gamma) [NCBI Gene 3458] {aka IFG, IFI, IMD69}, SIRT2 (sirtuin 2) [NCBI Gene 22933] {aka SIR2, SIR2L, SIR2L2}, MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, UCP2 (uncoupling protein 2) [NCBI Gene 7351] {aka BMIQ4, SLC25A8, UCPH}, CXCL10 (C-X-C motif chemokine ligand 10) [NCBI Gene 3627] {aka C7, IFI10, INP10, IP-10, SCYB10, crg-2}, IL17A (interleukin 17A) [NCBI Gene 3605] {aka CTLA-8, CTLA8, IL-17, IL-17A, IL17, ILA17}, IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, CRP (C-reactive protein) [NCBI Gene 1401] {aka PTX1}, THAS (thoracoabdominal syndrome) [NCBI Gene 7055] {aka TAS}, LGALS3BP (galectin 3 binding protein) [NCBI Gene 3959] {aka 90K, BTBD17B, CyCAP, M2BP, MAC-2-BP, TANGO10B}, CXCL5 (C-X-C motif chemokine ligand 5) [NCBI Gene 6374] {aka ENA-78, SCYB5}, SOD1 (superoxide dismutase 1) [NCBI Gene 6647] {aka ALS, ALS1, HEL-S-44, IPOA, SOD, STAHP}, VCAM1 (vascular cell adhesion molecule 1) [NCBI Gene 7412] {aka CD106, INCAM-100}, CXCL11 (C-X-C motif chemokine ligand 11) [NCBI Gene 6373] {aka H174, I-TAC, IP-9, IP9, SCYB11, SCYB9B}, ME2 (malic enzyme 2) [NCBI Gene 4200] {aka ODS1}, AXIN1 (axin 1) [NCBI Gene 8312] {aka AXIN, CMDOH, PPP1R49}, SERPINA1 (serpin family A member 1) [NCBI Gene 5265] {aka A1A, A1AT, AAT, PI, PI1, PRO2275}, CX3CL1 (C-X3-C motif chemokine ligand 1) [NCBI Gene 6376] {aka ABCD-3, C3Xkine, CXC3, CXC3C, NTN, NTT}, TGFB1 (transforming growth factor beta 1) [NCBI Gene 7040] {aka CAEND1, CED, DPD1, IBDIMDE, LAP, TGF-beta1}
- **Diseases:** cognitive fatigue (MESH:D005221), cognitive symptoms (MESH:D019954), mood (MESH:D019964), musculoskeletal pain (MESH:D059352), fibro (MESH:D009810), temporomandibular symptoms (MESH:D013705), concentration difficulties (MESH:C567712), affective dysregulation (MESH:D021081), inactivity (MESH:C564765), Sleep disturbances (MESH:D012893), Pain (MESH:D010146), gray and white matter abnormalities (MESH:D055652), Mitochondrial dysfunction (MESH:D028361), orthostatic intolerance (MESH:D054971), injury to (MESH:D014947), cephalalgia (MESH:D006261), inflammation (MESH:D007249), morning stiffness (MESH:D048968), small fiber neuropathy (MESH:D000071075), nociplastic pain disorder (MESH:D013001), sleep architecture disruption (MESH:D019958), edema (MESH:D004487), Neuroinflammation (MESH:D000090862), anxiety (MESH:D001007), myofascial pain (MESH:D009209), neuropsychiatric symptom (MESH:D001523), sensory disturbances (MESH:D012678), energy insufficiency (MESH:D000309), somatosensory lesions (MESH:D020886), dysesthesia (MESH:D010292), tenderness (MESH:D063806), neurogenic inflammation (MESH:D020078), hypersensitivity (MESH:D004342), IBS (MESH:D043183), neuronal injury (MESH:D009410), musculoskeletal stiffness (MESH:D009140), chronic pain (MESH:D059350), depressive affect (MESH:D003866), cognitive deficits (MESH:D003072), deficits in working memory (MESH:D008569), immune dysregulation (OMIM:614878), allodynia (MESH:D006930), rigidity (MESH:D009127), flexibility (MESH:D005413), HPA axis dysregulation (MESH:C566610), nociceptive (MESH:D059226), adrenal insensitivity (MESH:D013734), joint stiffness (MESH:C535724), dizziness (MESH:D004244), infection (MESH:D007239), Fibromyalgia (MESH:D005356), gastrointestinal disorders (MESH:D005767), immune abnormalities (MESH:D007154), executive and attentional deficits (MESH:D001289)
- **Chemicals:** C18:0 (MESH:C031183), PGE2 (MESH:D015232), leucine (MESH:D007930), xanthurenic acid (MESH:C028330), tyrosine (MESH:D014443), valine (MESH:D014633), xanthine (MESH:D019820), 3-hydroxykynurenine (MESH:C005045), malate (MESH:C030298), glycine (MESH:D005998), ceramides (MESH:D002518), quinolinic acid (MESH:D017378), GABA (MESH:D005680), BCAAs (MESH:D000597), norepinephrine (MESH:D009638), kynurenine (MESH:D007737), citrulline (MESH:D002956), glutamate (MESH:D018698), glycerophospholipid (MESH:D020404), hypoxanthine (MESH:D019271), Aromatic amino acids (MESH:D024322), pyruvate (MESH:D019289), inosine (MESH:D007288), succinate (MESH:D019802), TCA (MESH:D014233), epinephrine (MESH:D004837), lactate (MESH:D019344), cortisol (MESH:D006854), uric acid (MESH:D014527), MDA (MESH:D015104), duloxetine (MESH:D000068736), isoleucine (MESH:D007532), lipid (MESH:D008055), Purine (MESH:C030985), guanidinoacetate (MESH:C004946), ATP (MESH:D000255), citrate (MESH:D019343), Glutamine (MESH:D005973), serotonin (MESH:D012701), creatinine (MESH:D003404), ROS (MESH:D017382), milnacipran (MESH:D000078764), thromboxane B2 (MESH:D013929), sphingolipid (MESH:D013107), lysophosphatidylcholines (MESH:D008244), Tryptophan (MESH:D014364), fumarate (MESH:D005650), gabapentin (MESH:D000077206), leukotriene B4 (MESH:D007975), alpha-ketoglutarate (MESH:D007656), C16:0 (-), eicosanoid (MESH:D015777), ornithine (MESH:D009952), melatonin (MESH:D008550), sphingomyelins (MESH:D013109), pregabalin (MESH:D000069583), naltrexone (MESH:D009271), acylcarnitines (MESH:C116917), phenylalanine (MESH:D010649), phosphagen (MESH:D010725)
- **Species:** Homo sapiens (human, species) [taxon 9606]
- **Mutations:** glutamine/glutamate, glutamate/glutamine

## Full text

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## References

186 references — full list in the complete paper: https://tomesphere.com/paper/PMC12938316/full.md

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Source: https://tomesphere.com/paper/PMC12938316