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Structural and Functional Neuroimaging Findings in Fibromyalgia: A Systematic Review.

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Τίτλος: Structural and Functional Neuroimaging Findings in Fibromyalgia: A Systematic Review.
Συγγραφείς: Flutt FAD; Pain Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.; Graduate Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil., de Melo Cortez JP; Pain Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.; Emotion Neurophysiology Laboratory, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil., Ramos LR; Programa de Pós-Graduação Em Neurociências Translacional (PGNET), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Furlanetto RPP; Pain Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil., Corrêa DG; Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil., Villela NR; Pain Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.; Graduate Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.; Discipline of Neurosurgery, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
Πηγή: European journal of pain (London, England) [Eur J Pain] 2026 Jul; Vol. 30 (6), pp. e70331.
Τύπος έκδοσης: Journal Article; Systematic Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley Country of Publication: England NLM ID: 9801774 Publication Model: Print Cited Medium: Internet ISSN: 1532-2149 (Electronic) Linking ISSN: 10903801 NLM ISO Abbreviation: Eur J Pain Subsets: MEDLINE
Imprint Name(s): Publication: 2012- : Chichester, UK : Wiley
Original Publication: London ; Philadelphia : Saunders, c1997-
Ιατρικοί όροι (MeSH): Fibromyalgia*/diagnostic imaging , Fibromyalgia*/physiopathology , Fibromyalgia*/pathology , Brain*/diagnostic imaging , Brain*/physiopathology , Functional Neuroimaging*, Humans ; Magnetic Resonance Imaging ; Nociplastic Pain ; Neuroimaging
Περίληψη: Background and Objective: Fibromyalgia (FM) is a nociplastic chronic pain syndrome in which neuroimaging indicates central nervous system involvement, yet findings remain inconsistent across methods. We systematically reviewed structural and functional neuroimaging studies in adults with FM to identify the most reproducible cross-modal alterations.
Databases and Data Treatment: Following a PROSPERO-registered protocol (CRD420251234980) and PRISMA 2020, we searched PubMed, EMBASE, Web of Science and VHL/BVS for English-language studies published between 1 January 2010 and 16 October 2025. Eligible studies compared FM (any American College of Rheumatology criteria) with healthy controls and reported quantitative structural MRI, diffusion/structural connectivity or resting-state/task-based fMRI.
Results: Ninety-one studies were included (24 morphometry, 8 diffusion/structural connectivity, 32 resting-state fMRI, 40 task-based fMRI). Morphometry most consistently showed reduced grey matter volume or cortical thickness in anterior cingulate, insular and prefrontal/orbitofrontal cortices, with recurrent reductions in temporal cortex, posterior cingulate, amygdala and hippocampus; thalamic increases were less frequent. Diffusion findings were sparse and bidirectional, yielding no stable white-matter alterations. Resting-state fMRI was highly heterogeneous, with contradictory default-mode, salience/insula and periaqueductal grey (PAG)-related connectivity changes. Task-based fMRI provided the clearest support for central sensitization, showing hyper-responsivity of nociceptive networks with dysregulated prefrontal engagement and weakened rostral anterior cingulate cortex (rACC)-PAG/brainstem descending modulation.
Conclusions: FM shows distributed brain alterations, with the most robust signals reflecting nociceptive amplification and impaired top-down control. Harmonized longitudinal multimodal studies are needed to establish reliable biomarkers.
Significance Statement: This systematic review shows that fibromyalgia neuroimaging findings are not best explained by a single biomarker, but by distributed alterations across pain-processing, modulatory and affective-cognitive systems. By comparing structural MRI, diffusion imaging, resting-state fMRI and task-based fMRI, the review identifies task-evoked nociceptive amplification and impaired descending modulation as the most coherent cross-study signal, while clarifying why resting-state and diffusion findings remain difficult to translate clinically.
(© 2026 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)
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Entry Date(s): Date Created: 20260712 Date Completed: 20260712 Latest Revision: 20260813
Update Code: 20260814
PubMed Central ID: PMC13356883
DOI: 10.1002/ejp.70331
PMID: 42437468
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1532-2149
DOI:10.1002/ejp.70331