Imbalance of threat and soothing systems in fibromyalgia: rephrasing an established mechanistic model?

The study proposed a new model for fibromyalgia that suggests an imbalance in emotion regulation, resulting in an overactive 'threat' system and an underactive 'soothing' system that keeps the brain's 'salience network' in continuous alert mode. However, it overlooked the autonomic dysfunction seen in patients with fibromyalgia, which provides a better explanation for the multisystem symptoms of the condition. The study also ignored the evidence suggesting small nerve fibre pathology and dorsal root ganglia as key neural hubs for fibromyalgia. The proposed model differs from the previously described hypothesis suggesting fibromyalgia is a stress-evoked sympathetically maintained neuropathic pain syndrome.