Hypothetical model ignores many important pathophysiologic mechanisms in fibromyalgia

Daniel J Clauw* (Corresponding Author), Ernest H S Choy, Vitaly Napadow, Anushka Soni, Kevin F Boehnke, Bruce Naliboff, Afton L Hassett, Anne Arewasikporn, Andrew Schrepf, Chelsea M Kaplan, David Williams, Neil Basu, Rachel S Bergmans, Richard E Harris, Steven E Harte, Andrea Chadwick, Gary J Macfarlane

*Corresponding author for this work

Research output: Contribution to journalComment/debatepeer-review

2 Citations (Scopus)


We would like to respond to the Perspective article by Pinto et al. (Pinto, A. M. et al. Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia. Nat. Rev. Rheumatol. 19, 44–60 (2023))1. We feel that the proposed model severely overfits the complicated pathophysiology of fibromyalgia and is not applicable to all or even most individuals with this condition. We are concerned that this theory could inadvertently drive the field backwards despite several decades of research that has begun to illuminate neurobiological mechanisms underlying fibromyalgia and other chronic pain conditions. Our main points are outlined here.
Original languageEnglish
Pages (from-to)321
Number of pages1
JournalNature Reviews Rheumatology
Early online date24 Mar 2023
Publication statusPublished - May 2023

Bibliographical note

There is a reply to this letter by Pinto et al. Nat. Rev. Rheumatol. https://doi.org/10.1038/s41584-023-00952-2 (2023).


  • Chronic pain
  • somatosensory system


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