An Updated Overview of the Neurophysiological and Psychosocial Dimensions of Fibromyalgia &amp;ndash; A Call for an Integrative Model

Pinto, Ana Margarida; Geenen, Rinie; Palavra, Filipe; Lumley, Mark A.; Ablin, Jacob N; Amris, Kirstine; Branco, Jaime; Buskila, Dan; Castelo‐Branco, Miguel; Crofford, Leslie J.; Fitzcharles, Mary‐Ann; Luís, Mariana; Marques, Tiago Reis; Rhudy, Jamie L.; Uddin, Lucina Q.; Castilho, Paula; Jacobs, Johannes W. G.; Silva, José António Pereira da

doi:10.20944/preprints202007.0224.v1

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“…The current perspective is depicted in Fig. 1 (adapted from Häuser et al 3 and briefly summarized in this section); more information on the processes involved can be found in wide-scope reviews 3,4,[11][12][13] and in a comprehensive review we performed as the first step in the development of the integrative model presented herein 14 .…”

Section: A Leading Model Of Fibromyalgiamentioning

confidence: 99%

Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia

et al. 2022

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Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.Sections 'chronic primary pain', a new major category comprising five subtypes that reflect the distinct anatomical sites or body systems affected by pain 23 . Fibromyalgia belongs to the 'chronic widespread pain' subtype; the other four are complex regional pain syndrome, chronic primary headache or orofacial pain, chronic primary visceral pain, and chronic primary musculoskeletal pain.An even wider scope emerges when the broader overarching concept of central sensitivity syndromes is considered 24 . Central sensitivity syndromes comprise most COPCs as well as conditions not primarily typified by pain, such as periodic limb movement in sleep, multiple chemical sensitivity, female urethral syndrome and post-traumatic stress disorder 24 (see Fig. 2). All these conditions share evidence of central sensitivity and, to a lesser extent, similar neurotransmitter imbalance. They all show small-to-moderate response to serotoninnorepinephrine reuptake inhibitors and other centrally acting agents (for example, gabapentinoids) and little to no response to NSAIDs and opioids. These central sensitivity syndromes are frequently comorbid, are more common in women than in men, have a high prevalence of stress-related manifestations and psychopathology, and are associated with high sensitivity to daily and chronic stressors and increased sensitivity to everyday environmental sensory stimuli 24 .

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