Resolution criteria

This market resolves YES if peer-reviewed research demonstrates that fibromyalgia reflects a single underlying condition or unified pathophysiology, rather than multiple distinct conditions. Resolution requires evidence that:

• A single biological mechanism (e.g., central sensitization, neuroinflammation, immune dysfunction) is identified as the primary driver of fibromyalgia symptoms across patient populations, OR

• Validated biomarkers establish fibromyalgia as a distinct, unified disease entity with consistent biological signatures

Resolution sources: PubMed (https://pubmed.ncbi.nlm.nih.gov/), peer-reviewed journals indexed in MEDLINE, and major medical institutions' published research findings.

The market resolves NO if research continues to support the current understanding that fibromyalgia involves multiple contributing pathways or represents a heterogeneous syndrome without a single unifying mechanism.

Background

Experts have not identified a single cause of fibromyalgia, instead believing that a combination of multiple physical and emotional stressors can trigger or worsen symptoms. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing, and this condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology.

Diagnosis of fibromyalgia is hampered by the lack of any single pathological feature, laboratory finding, or biomarker. Recent research has identified promising biomarker candidates: a study successfully identifies three diagnostic biomarkers for FM, supported by both bioinformatics analysis and machine learning models. Additionally, dorsal root ganglia seem to play a crucial role in the pathogenesis of FM as they host satellite glial cells, which are targeted by pain-driving immunoglobulin G.

Considerations

The question hinges on how "one main condition" is defined. Current research suggests fibromyalgia may have a common central mechanism (central sensitization), but whether this constitutes a "single condition" versus a syndrome with multiple contributing pathways remains debated. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area. The discovery of reliable biomarkers may clarify whether fibromyalgia is fundamentally one condition or multiple related conditions sharing overlapping features.