The Hidden Burden: A Retrospective Analysis of Multisystem Comorbidities in Patients with Fibromyalgia

Background: Fibromyalgia (FM) is a chronic widespread pain disorder increasingly recognized as a multisystem condition. Comorbidities across cardiometabolic, rheumatologic, psychiatric, gastrointestinal, neurological, and functional domains significantly contribute to the disease burden. Systematic data on the multisystem comorbidity profile of FM from Indian tertiary care settings remain scarce. Objective: To determine the prevalence and pattern of multisystem comorbidities in FM patients at a tertiary care pain medicine center. Materials and Methods: Medical records of 400 FM patients (2016 American College of Rheumatology criteria, age ≥18 years) attending a pain clinic (January 2022–March 2026) were retrospectively reviewed. Comorbidities across six organ-system domains were ascertained from documented diagnoses and recorded using binary coding. Prevalence was reported as frequency and percentage with 95% Wilson confidence intervals. Exploratory analyses employed chi-square tests, t tests, Mann–Whitney U tests, one-way analysis of variance, and Pearson correlation, as appropriate. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed throughout. Results: The cohort was predominantly female (80.5%), with a mean age of 46.7 ± 12.4 years. Cardiometabolic comorbidities were the most prevalent, including obesity (35.8%), hypertension (16.2%), and type 2 diabetes mellitus (12.5%). Migraine was documented in 3.8%, rheumatoid arthritis in 4.0%, and depression in 2.5%. Most patients had a low comorbidity burden (61.3%), followed by moderate (33.5%) and high (5.2%) burden. Comorbidity burden increased significantly with age ( P = 0.002) and was positively correlated with body mass index ( r = 0.45, P < 0.001). Conclusion: Cardiometabolic comorbidities dominated the FM burden in this study. The findings suggest substantial under-recognition of non-cardiometabolic comorbidities in routine clinical practice.