ReviewNature reviews. Rheumatology2023
Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia.
Review in Nature reviews. Rheumatology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 75 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
75 citing papers in PubMed, 2 syntheses or guidelines pooled it, 115 citations in OpenAlex.
- Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis.JAMA network open · 2025Pooled it
- A systematic review and meta-analysis of voxel-based morphometric studies of fibromyalgia.Frontiers in neuroscience · 2023Pooled it
- Targeted limbic self-neuromodulation for alleviating central sensitization symptoms in fibromyalgia.BMC medicine · 2025Trial
- Meditations on Methodological Issues in Clinical Investigations of "Central Sensitization" (Jonah XII).Journal of clinical medicine · 2026Article
- Chiropractic Care Is Associated with Frequency-Specific Reorganisation of Triple-Network Brain Dynamics: A Source-Localised EEG Study.Brain sciences · 2026Article
- Understanding fibromyalgia beyond pain: emotional imbalance and the case for compassionate care.RMD open · 2026Review
- Prepulse inhibition of the blink reflex in functional neurological disorder and fibromyalgia.Brain : a journal of neurology · 2026Article
- When emotions hurt: negative interpretations of bodily signals and interoceptive difficulties in fibromyalgia.Psychological research · 2026Article
- A systematic scoping review and conceptual analysis of new-onset fibromyalgia manifestations after non-hospitalized COVID-19: empirics, definitions, methodologies, pathophysiology, mapping of literature, and knowledge gaps.Journal of translational medicine · 2026Article
- High Prevalence and Clinical Impact of Fibromyalgia in Functional Motor Disorder.Movement disorders clinical practice · 2026Article
- An fMRI-informed EEG model of the amygdala is associated with salience network dynamics during naturalistic emotional stimulation.Molecular psychiatry · 2026Article
- Identifying fibromyalgia phenotypes based on psychological symptom burden.Nature reviews. Rheumatology · 2026Article
- Distinct effects of fibromyalgia pain, depression and anxiety on perception of affective touch and pain.The Journal of physiology · 2026Article
- Unravelling Fibromyalgia in Psoriatic Arthritis.Rheumatology and therapy · 2026Review
- The Relationship Between Pain and Depression in Fibromyalgia: Structural Equation Modeling and Network Analysis.International journal of environmental research and public health · 2026Article
- Cerebellar Tissue Properties Alterations in Fibromyalgia: A T1w/T2w Ratio Study.Human brain mapping · 2026Article
- MASSAG model: Towards an integrative neuroscience framework linking emotional trauma, pain, and mechanisms of force-based manipulations.Neuroscience and biobehavioral reviews · 2026Review
- Exploring the role of shame and self-compassion on the link between fibromyalgia symptoms and depression: Insights from mediation and moderation analyses.Journal of health psychology · 2026Article
- Which facets of emotion dysregulation are uniquely associated with emotional allodynia in fibromyalgia? A preliminary analysis using the emotional allodynia questionnaire and the difficulties in emotion regulation scale.Frontiers in psychology · 2026Article
- Neurobiological mechanisms and treatment of empathic pain in nonsuicidal self-injury.Frontiers in psychiatry · 2026Review
15 more citing papers are in PubMed but not listed here.
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Authors and funding
24 authors at 19 institutions in 10 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.