Fibromyalgia and Associated Disorders: From Pain to Chronic Suffering, From Subjective Hypersensitivity to Hypersensitivity Syndrome.
Maugars, Yves, Berthelot, Jean-Marie, Le Goff, Benoit et al. · Frontiers in medicine · 2021 · DOI
Quick Summary
This article reviews what scientists know about fibromyalgia as of 2020, including how it's diagnosed and why it happens. The authors explain that fibromyalgia involves the brain processing pain signals too intensely, and that people with fibromyalgia often experience many other symptoms like fatigue, sleep problems, and sensitivity to sounds, lights, and touch. They also discuss how fibromyalgia shares common features with other conditions like ME/CFS, all involving a heightened sensitivity to stimuli controlled by the central nervous system.
Why It Matters
This review is important because it positions ME/CFS as part of a recognized family of central hypersensitivity syndromes, validating the legitimacy of neurobiological mechanisms underlying these conditions. For ME/CFS patients, the framework helps explain why they experience multi-system sensory and autonomic symptoms, and suggests that research into fibromyalgia mechanisms may yield insights applicable to ME/CFS pathophysiology.
Observed Findings
Fibromyalgia involves amplified pain and sensory nociception with decreased pain perception thresholds
Fatigue and sleep disorders frequently precede pain amplification and occur in a characteristic chronological sequence
Neuroimaging reveals a central neurological signature of cortical dysfunction in pain processing
Multiple associated symptoms cluster together with core pain and fatigue, suggesting shared hypersensitivity mechanisms
ME/CFS, fibromyalgia, and restless legs syndrome share common features of heightened sensitivity to exteroceptive stimuli and autonomic dysfunction
Inferred Conclusions
Fibromyalgia is best understood as a central nervous system disorder of pain and sensory integration rather than a peripheral tissue disorder
Fibromyalgia belongs to a broader category of central hypersensitivity syndromes that share common mechanisms of amplified stimulus perception
Post-traumatic stress, chronic fatigue, and pain amplification may follow a characteristic sequence, with sleep disturbance playing an important intermediary role
Cognitive and psychological factors (catastrophizing, coping) interact with neurobiological hypersensitivity to maintain chronicity
Remaining Questions
What This Study Does Not Prove
This editorial does not present new experimental data or prove causality—it synthesizes existing knowledge. It does not establish the precise neurobiological mechanisms driving hypersensitivity, nor does it demonstrate that all patients with ME/CFS and fibromyalgia share identical pathways. The review cannot determine whether these are truly separate conditions or manifestations of a single underlying disorder.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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