A systematic scoping review and conceptual analysis of new-onset fibromyalgia manifestations after non-hospitalized COVID-19: empirics, definitions, methodologies, pathophysiology, mapping of literature, and knowledge gaps.

Publication date: May 23, 2026

The global coronavirus pandemic has led to a quiet wave of a chronic illness referred to as ‘Long/Post Covid-19 syndrome’ (LC) which bears a notable resemblance to functional-somatic or ‘fibromyalgia-type’ syndromes, and whose pathophysiology is undetermined. The lack of effective therapies for LC is straining healthcare systems worldwide and causing widespread public health and socioeconomic concerns. “Fibromyalgia” is a controversial chronic pain condition of unknown etiology largely attributed to generalized sensory hypersensitivity due to dysregulated central pain processing pathways (i. e. neuroplasting central sensitization). Despite intense research and growing attention in the scientific community, the clinical overlap of fibromyalgia, somatic symptom disorder, and post-viral chronic fatigue, is a medical puzzle yet to be solved, especially when occurring in non-severe infections and previously healthy individuals. This systematic scoping review covers the empirical findings on new-onset fibromyalgia manifestations after non-hospitalized covid-19. MEDLINE, Web of Science, and APA PsycINFO were searched in a systematic scoping approach for empirical studies on new-onset fibromyalgia after non-severe non-hospitalized covid-19, charting study characteristics and outcome data. A total of 228 records were included. Various types of methods, tools, and study designs are being used for LC research, with inconsistency in key concepts and definitions. This leads to a fragmented understanding of the relationship between SARS-CoV-2 infection and LC. Prevalence studies of post-Covid fibromyalgia are ongoing and susceptible to bias. The empirical evidence supports an overlap between LC, chronic fatigue syndrome, and fibromyalgia but the molecular mechanisms still remain unclear. There are conflicting findings regarding presence of viral particles, central sensitization, autoantibodies, and more. This review highlights the need for standardized definitions and rigorous methodologies in research on LC. Future research should focus on epidemiological population-based studies with representative sampling and improving methodology, refining evolving definitions, harmonization of research, elucidating neurological mechanisms in hypothesis driven studies, and developing effective therapeutic strategies. The discussion synthesizes findings and offers an integrative mechanism for the pathophysiology of fibromyalgia and multisystem medically unexplained manifestations of LC as a non-autoimmune connective tissue disease. It helps explain neuropsychiatric and psychosomatic manifestations and is used to make testable theory-based predictions for future hypothesis-driven investigations.

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Concepts Keywords
Bears Fascial armoring
Coronavirus Fibromyalgia
Fibromyalgia Long COVID-19
Healthcare Myofibroblast
Systematic Psychosomatic

Semantics

Type Source Name
disease MESH fibromyalgia
disease MESH COVID-19
disease MESH chronic illness
disease MESH Post Covid-19 syndrome
disease MESH syndromes
disease MESH chronic pain
disease MESH pain
disease MESH somatic symptom
disease MESH infections
disease MESH included
pathway REACTOME SARS-CoV-2 Infection
disease MESH chronic fatigue syndrome
disease MESH connective tissue disease
pathway REACTOME Reproduction
drug DRUGBANK Coenzyme M
disease MESH severe acute respiratory syndrome
drug DRUGBANK Factor IX Complex (Human)
disease MESH PCC
disease MESH viral infection
disease MESH fatigue
disease MESH arthralgia
disease MESH myalgia
disease MESH musculoskeletal pain
pathway REACTOME Translation
disease MESH pain disorder
disease MESH nociplastic pain
disease MESH Myofascial Pain Syndromes
disease MESH blood clots
disease MESH myocarditis
disease MESH pneumonia
disease MESH fibrosis
disease MESH joint hypermobility
disease MESH rheumatoid arthritis
pathway KEGG Rheumatoid arthritis
disease MESH hyposmia
disease MESH headache
disease MESH back pain
disease MESH hearing impairment
disease MESH constipation
disease MESH chest pain
disease MESH dizziness
disease MESH cough
disease MESH diarrhea
disease MESH dyspnea
disease MESH cognitive decline
disease MESH brain fog
disease MESH relapse
disease MESH chronic cough
disease MESH abnormal movements
disease MESH Insomnia
disease MESH FSS
disease MESH Anxiety
disease MESH irritable bowel syndrome
disease MESH mechanical allodynia
disease MESH CESD
disease MESH DASS
disease MESH SSD
drug DRUGBANK Isoxaflutole
disease MESH PCS
disease MESH orthostatic intolerance
disease MESH SCD
disease MESH Kinesiophobia
disease MESH injury
disease MESH Low Back pain
disease MESH small fiber neuropathy
disease MESH mitochondrial dysfunction
disease MESH cytokine storm
disease MESH dysbiosis
disease MESH dysautonomia
disease MESH hypoxia
disease MESH inflammatory myopathy
disease MESH neuroinflammation
disease MESH mental illness
disease MESH amyloid deposits
disease MESH asymptomatic infection
disease MESH strains
disease MESH migraine
disease MESH type 2 diabetes
disease MESH neurological disorders
disease MESH coronavirus infection
disease MESH ICD
disease MESH obesity
drug DRUGBANK Methionine
pathway REACTOME Metabolism
pathway KEGG Circadian rhythm
pathway REACTOME GABA synthesis
pathway KEGG Synaptic vesicle cycle
disease MESH multiple sclerosis
disease MESH neurological manifestations
disease MESH cord
disease MESH allergies
disease MESH mood disorders
disease MESH gastrointestinal disorders
disease MESH cardiac disorders
disease MESH Ehlers Danlos Syndrome
disease MESH inflammation
drug DRUGBANK Folic Acid
drug DRUGBANK Creatine
drug DRUGBANK Ginseng
drug DRUGBANK Ubidecarenone
drug DRUGBANK Lipoic Acid
drug DRUGBANK Melatonin
drug DRUGBANK Naltrexone
drug DRUGBANK Metformin
drug DRUGBANK Colchicine
drug DRUGBANK Oxygen
drug DRUGBANK Levocarnitine
drug DRUGBANK Propranolol
drug DRUGBANK Gabapentin
drug DRUGBANK Pregabalin
drug DRUGBANK Amitriptyline
drug DRUGBANK Guanfacine
drug DRUGBANK L-Cysteine
drug DRUGBANK Midodrine
drug DRUGBANK Fludrocortisone
drug DRUGBANK Aripiprazole
drug DRUGBANK Pyridostigmine
drug DRUGBANK Acetylcysteine
drug DRUGBANK Fisetin
disease MESH overweight
disease MESH confusion
disease MESH fever
disease MESH alopecia
disease MESH restless legs
disease MESH wheezing
disease MESH gastroesophageal reflux
disease MESH dry eyes
disease MESH multiple chemical sensitivity
disease MESH itching
disease MESH spasms
disease MESH dissociation
disease MESH peripheral neuropathy
pathway REACTOME Adaptive Immune System
disease MESH cognitive symptoms
disease MESH ischemia
disease MESH contracture
pathway KEGG Focal adhesion
disease MESH scar
disease MESH asthma
pathway KEGG Asthma
drug DRUGBANK Resveratrol
pathway REACTOME Apoptosis
drug DRUGBANK Calcium
drug DRUGBANK ATP
pathway REACTOME Release
disease MESH tumor
drug DRUGBANK Albendazole
disease MESH pulmonary fibrosis
disease MESH chronic exertional compartment syndrome
drug DRUGBANK Aspartame
disease MESH acute pain

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