Fibromyalgia and post-traumatic stress disorder: different parts of an elephant?

Abstract

Post-traumatic stress disorder (PTSD) and fibromyalgia (FM) are prevalent and debilitating conditions, conventionally delineated by distinct symptom profiles: PTSD is typified by intrusive thoughts and avoidance behaviours, while FM is essentially characterised by widespread pain, cognitive disturbances and fatigue. Despite these differences in definition, these disorders share a multitude of clinical features and risk factors, including persistent psychological distress. Furthermore, they often co-occur. Hyperactivity of the salience network, recognised as a key pathogenic feature of PTSD, has been recently suggested to also underlie FM, broadening the prevailing concept of central pain sensitisation. These observations prompt the hypothesis that these conditions have common vulnerability factors, characterised by a maladaptive response to stress perpetuated by a persistently heightened perception of threat and low ability to sooth the threats.This paper explores this hypothesis, by analysing the commonalities between FM and PTSD, in line with the FITSS model, and how this may, eventually, foster cross-fertilisation of knowledge stemming from both perspectives, to the benefit of patients.