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I think that you are right in suggesting that pain and increased ventricular lactate in FM may have a different mechanistic underpinning (than in ME/CFS) and a strong candidate is neuroinflammation

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Future research directions for GDMT in heart failure could include personalized medicine approaches to identify factors influencing individual response to treatment, exploration of novel therapies such as gene or cell-based therapies, evaluation of interventions to improve patient adherence to GDMT, comparative effectiveness research to optimize treatment choices, assessment of health system interventions and their impact on GDMT implementation, examination of health disparities in access and outcomes, utilization of real-world data and implementation science approaches, and incorporation of patient-reported outcomes in research

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