Chronic Pain · 纖維肌痛症與慢性疼痛文獻日報

#1

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高實用性

Catecholamine-mediated release of miR-133a-3p from adipocytes regulates the onset of chronic primary pain.

The Journal of clinical investigation · Catecholamine-mediated release of miR-133a-3p from adipocytes regulates the onset of chronic primary pain.

發現脂肪細胞透過去甲腎上腺素釋放miR-133a-3p至脊髓，調節疼痛相關基因，其下調與纖維肌痛等原發性慢性疼痛相關，提供新分子機制與治療標的。

P患有≥1種原發性慢性疼痛（CPPC）的人類及動物模型（纖維肌痛、 vestibulodynia）

I脂肪細胞中miR-133a-3p的去甲腎上腺素介導釋放

C對照組：未經去甲腎上腺素刺激或miR-133a-3p正常表達組

OmiR-133a-3p在CPPC患者血漿中顯著下調；其過表達逆轉動物模型的機械過敏，證明其在脊髓調節MAP3K3等痛覚神經元活化基因中的功能

纖維肌痛症慢性疼痛生物標記神經科學免疫學基因調控

#2

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高實用性

Preliminary Investigation of Disorders of Gut-Brain Interaction and Their Associations With Psychological Flexibility and Daily Functioning in People With Fibromyalgia.

European journal of pain (London, England) · Preliminary Investigation of Disorders of Gut-Brain Interaction and Their Associations With Psychological Flexibility and Daily Functioning in People With Fibromyalgia.

79.2%纖維肌痛患者併發腸腦互動障礙（DGBI），多重DGBI顯著惡化日常功能，心理彈性（PF）部分緩解胃腸症狀對憂鬱與功能的負面影響，提示ACT等干預具潛在臨床價值。

P395名成年纖維肌痛患者（線上調查）

I評估腸腦互動障礙（DGBI）併發率、胃腸症狀嚴重程度、心理彈性（PF）

C無DGBI vs. 有單一或多重DGBI組；低PF vs. 高PF組

ODGBI併發率高（79.2%）；多重DGBI與更糟日常功能相關（p<.001）；胃腸症狀與憂鬱、功能障礙正相關（r=0.41-0.56）；PF顯著緩解此關係（b=0.05-0.13）

纖維肌痛症慢性疼痛心理治療ACT生活品質腸腦互動

#3

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高實用性

Effectiveness of a 6-Month Land-Based and Water-Based Exercise Intervention on Body Composition and Physical Fitness in Women With Fibromyalgia: The Al-Ándalus Quasi-experimental Study.

Archives of physical medicine and rehabilitation · Effectiveness of a 6-Month Land-Based and Water-Based Exercise Intervention on Body Composition and Physical Fitness in Women With Fibromyalgia: The Al-Ándalus Quasi-experimental Study.

陸基運動較水性運動更有效減脂肪、增肌肉、提升力量、柔韌度、敏捷性及心肺耐力，且效果在隨訪6個月後仍持續，證實陸基運動為纖維肌痛女性優選復健方案。

P250名女性纖維肌痛患者

I陸基運動組（n=83） vs. 水性運動組（n=85） vs. 常規照護（n=82），持續6個月

C陸基 vs. 水性 vs. 常規照護；運動 vs. 無運動

O陸基組顯著減少脂肪量（-2%）、增加肌肉量（+1kg）、提升上下肢力量、柔韌度、敏捷性及心肺耐力（43m行走距離增加），隨訪後效果更佳（37m）；水性組僅維持上肢力量

纖維肌痛症運動治療復健治療物理治療生活品質

#4

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中實用性

The effects of neuromodulation through brainwave entrainment on pain in women with fibromyalgia: a randomized controlled clinical trial with follow-up.

Pain medicine (Malden, Mass.) · The effects of neuromodulation through brainwave entrainment on pain in women with fibromyalgia: a randomized controlled clinical trial with follow-up.

8週脑波同步（BWE）療法顯著減少疼痛（VAS、MPQ）、焦慮、抑鬱，並提升生活品質，機制可能涉及降低氧化應激與BDNF，效果優於音樂療法。

P84名女性纖維肌痛患者

I脑波同步（BWE，使用BrainTap頭帶） vs. 音樂療法，每日20分鐘，週5次，8週

CBWE組 vs. 音樂療法組 vs. 基線

OBWE組疼痛顯著下降（p=.0001）、焦慮減少（p=.006）、生活品質改善（p=.002）、抑鬱下降（p=.0001）、氧化應激與BDNF降低；效果在6月隨訪後維持

纖維肌痛症神經調節心理治療生活品質臨床試驗

#5

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中實用性

Prevalence of Attention Deficit Hyperactivity Disorder in Adult Patients With Fibromyalgia.

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases · Prevalence of Attention Deficit Hyperactivity Disorder in Adult Patients With Fibromyalgia.

61.7%纖維肌痛患者併存成人多動症（ADHD），其中48.6%為未診斷的成年型ADHD，提醒�床需主動篩檢此共病以避免診斷延誤。

P60名符合ACR 2016標準的纖維肌痛患者（無認知障礙） vs. 71名年齡、性別、教育程度匹配對照

I使用Conners CPT II評估成人ADHD，WURS評估童年ADHD症狀

C纖維肌痛組 vs. 對照組；有童年ADHD症狀 vs. 無

O纖維肌痛患者ADHD患病率61.7%（對照23.9%）；48.6%為未診斷童年ADHD；童年ADHD症狀強烈預測成人ADHD（OR=62.3）

纖維肌痛症慢性疼痛憂鬱症焦慮症診斷流行病學性別差異

#6

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中實用性

IgG Glycosylation Patterns May Identify Distinct Clinical Trajectories in Fibromyalgia Patients: A Longitudinal Pilot Study.

European journal of pain (London, England) · IgG Glycosylation Patterns May Identify Distinct Clinical Trajectories in Fibromyalgia Patients: A Longitudinal Pilot Study.

纖維肌痛患者IgG3/4半乳糖基化水平的變化與6個月後焦慮、憂鬱、功能影響（FIQ）的改善顯著相關（r=-0.76至-0.77），提示其為追蹤情緒與功能軌跡的潛在生物標記。

P30名纖維肌痛患者 vs. 30名健康對照

I追蹤IgG1、IgG2、IgG3/4糖基化基線與6個月後變化，並評估睡眠、焦慮（BAI）、憂鬱（BDI）、疼痛、功能（FIQ）

C基線 vs. 6個月；高變化組 vs. 低變化組（經階層聚類分群）

O雖整體PLS模型不顯著，但經探索性縮減模型確認IgG3/4半乳糖基化軸與BAI（r=-0.76）、BDI（r=-0.77）、FIQ（r=-0.76）顯著負相關

纖維肌痛症生物標記免疫學縱向研究

#7

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低實用性

Assessment of the 2D:4D Digit Ratio in Women With Fibromyalgia: Traces of Prenatal Hormonal Exposure.

American journal of human biology : the official journal of the Human Biology Council · Assessment of the 2D:4D Digit Ratio in Women With Fibromyalgia: Traces of Prenatal Hormonal Exposure.

纖維肌痛女性雙手2D:4D指數比顯著低於對照（右手：0.991 vs 1.022，左手：0.999 vs 1.021），提示胎盤雄激素暴露可能與後來發病相關，右手比具較佳區分力。

P57名纖維肌痛女性 vs. 32名年齡匹配健康女性對照

I使用數位卡尺量測雙手食指（2D）與無名指（4D）長度，計算2D:4D比

C患者組 vs. 對照組；右手 vs. 左手

O右手2D:4D顯著降低（p<.001，Cohen's d=-1.18）；左手亦顯著降低（p<.001，d=-0.98）；右手區分力更強

纖維肌痛症生物標記診斷內分泌學

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中

Alexithymia moderates brain function during suppression of negative emotions in fibromyalgia.

Pain

得失思癥（Alexithymia）調節纖維肌痛患者在負面情緒抑制時腦網絡連接，特別是降低健康對照的杏核-舌束連接，但對纖維肌痛組無此調節效應，提示情感意識缺損是神經功能失調的關鍵。

纖維肌痛症慢性疼痛心理治療神經影像情緒調節

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中

Prevalence and clinical factors associated with difficult-to-manage axial spondyloarthritis: a multicentre Italian cohort study with meta-analysis.

Therapeutic advances in musculoskeletal disease

纖維肌痛是難治性axial脊椎關節炎（D2M-axSpA）的獨立危險因素（OR=5.5），提示併存纖維肌痛顯著增加治療複雜度與病 burden。

纖維肌痛症慢性疼痛免疫學流行病學併發症

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Hypermobile Ehlers-Danlos Syndrome and Widespread Pain: Beyond Structural Laxity.

Joint bone spine

未提供摘要，但標題 suggess 探討過度活動型Ehlers-Danlos syndrome 與廣泛性疼痛的關係，可能涉及纖維肌痛併發。

纖維肌痛症慢性疼痛結缔組織疾病

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Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society.

Headache

提供成人偏頭痛預防藥物治療的指南，特別提及纖維肌痛、肥胖、高血壓等族群的用藥考量，但焦點非纖維肌痛。

藥物治療偏頭痛纖維肌痛症

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低

Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society.

Neurology

與Headache期刊重複內容，提供偏頭痛預防藥物指南，僅提及纖維肌痛作為考量因素之一。

藥物治療偏頭痛纖維肌痛症

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中

Clinical impact of nociplastic symptom burden in individuals with fibromyalgia syndrome.

Pain management

纖維肌痛患者nociplastic症狀負荷與病情嚴重度、生活品質差、疼痛災難化顯著正相關，證明此類症狀是核心病理表現。

纖維肌痛症慢性疼痛疼痛機制生活品質

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低

Comment on "Abnormal Resting-State Functional Connectivity Between the Dorsal Anterior Cingulate Cortex and the Limbic System Contributes to Pain and Emotion Regulation Impairment in Fibromyalgia Patients".

International journal of rheumatic diseases

未提供摘要，屬於評論文章，臨床價值有限。

纖維肌痛症神經影像情緒調節

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中

Associations between osteoarthritis and comorbidities before and after diagnosis across four European primary care databases: a multinational case-control and cohort study.

The Lancet regional health. Europe

骨關節炎併發纖維肌痛的風險顯著增加（aOR 1.93），提示兩種常見慢性疼痛病症具有共享風險或病理機制。

纖維肌痛症慢性疼痛併發症流行病學

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中

A scoping review on the characteristics of chronic pain registries.

Pain reports

全球慢性疼痛登記系統分散，多聚焦於頭痛、偏頭痛與纖維肌痛，但缺乏機制分類與社會經濟數據，限制其比較價值與政策制定效用。

慢性疼痛系統性回顧登記研究資料科學

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低

Does maladaptive microvascular flow redistribution cause tissue hypoxia in fibromyalgia?

Pain reports

提出纖維肌痛可能涉及毛細血管流量異常分流導致組織缺氧的假設，但證據仍為間接，需實證驗證。

纖維肌痛症慢性疼痛疼痛機制微循環

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中

Effects of N-methyl-d-aspartate receptor modulation on brain glutamate, functional connectivity, and clinical symptoms in fibromyalgia.

Pain reports

NYX-2925（NMDA受體調節劑）在探索性試驗中顯示減少腦谷氨酸與改善疼痛疲勞，但後續較大試驗未重現臨床獲益，提示其機制研究價值高而臨床轉譯尚需謹慎。

纖維肌痛症藥物治療神經影像神經調節臨床試驗

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低

The role of the kynurenine pathway in the pathogenesis of pain and affective disorders after traumatic brain injury.

Brain, behavior, & immunity - health

創傷性腦損傷後酪氨酸代謝異常（Kynurenine pathway）可能連結慢性疼痛與憂鬱，但文獻為敘述性綜述，未提供新纖維肌痛證據。

慢性疼痛憂鬱症神經科學代謝途徑

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中

Longitudinal stability of data-driven fibromyalgia phenotypes across repeated clinical assessments.

Pain reports

透過無監督分群識別出兩種纖維肌痛表型（低嚴重度/保留功能 vs 高嚴重度/全球受損），在6個月隨訪中約65%參與者保持穩定，支持其為持久�床構念。

纖維肌痛症慢性疼痛表型分析縱向研究

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低

Perceptions of Fibromyalgia Across Career Stages: Survey Results From Internal Medicine Physicians and Medical Students.

Musculoskeletal care

未提供摘要，但主題涉及內科醫師與醫學生對纖維肌痛的認知隨職涯階段變化，臨床啟發性有待全文。

纖維肌痛症醫師教育社會心理

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中

Targeting TRPA1 antagonists for nociplastic pain: systematic review and meta-analysis of preclinical evidence.

European journal of pharmacology

前臨床證據支持TRPA1拮抗劑於多種nociplastic疼痛模型（含reserpine誘發纖維肌痛）具有持續止痛效應，尤其在CPIP與偏頭痛模型證據質量較高。

纖維肌痛症慢性疼痛藥物治療系統性回顧前臨床

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低

Fibromyalgia: a real phantom pain?

Clinical rheumatology

探討纖維肌痛與幻肢疼痛在「無組織損傷處感覺疼痛」的相似性，討論中樞敏感化與DRG的角色，但為觀點文章，缺乏新實證。

纖維肌痛症慢性疼痛疼痛機制中樞敏感化

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中

Antihyperalgesic and antiallodynic effects of Salvia rosmarinus Spenn. extracts and some of their bioactive metabolites in a murine fibromyalgia pain model.

Journal of ethnopharmacology

迷迭香提取物（特別是乙醇萃取）及其代謝物（hesperidin、咖啡酸、柠檬烯）在reserpine誘發的大鼠纖維肌痛模型中顯著減輕機械與熱痛過敏，支持其為潛在天然療法。

纖維肌痛症藥物治療天然產物前臨床

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中

Integrative Analysis of Hub Genes and miRNAs Reveals Inflammatory and Structural Signatures in Fibromyalgia and Their Modulation Following Manual Therapy.

Omics : a journal of integrative biology

纖維肌痛表現炎症（IL6、TNF、CXCL8、STAT1）與結構（COL1A1、COL3A1、FN1、ITGB1）雙軸異常，手法治療可部分逆轉此分子特徵，支持其調節潛力。

纖維肌痛症慢性疼痛基因表達miRNA手法治療分子醫學

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中

Fibromyalgia in patients with idiopathic inflammatory myopathies: prevalence, associated factors, and relationship with patient outcomes and health care utilization.

Clinical rheumatology

約三分之一肌肉炎患者併發纖維肌痛（34%），併發者較年輕、教育程度較低、滿意度較低、醫療使用更高，提醒風濕科需主動篩檢。

纖維肌痛症慢性疼痛併發症風濕病醫療資源 utilisation

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低

Impact of creatine supplementation alone or combined with exercise on inflammatory and clinical outcomes in chronic musculoskeletal pain treated in the rheumatological field: a systematic review.

Nutrition (Burbank, Los Angeles County, Calif.)

輔助酮酸單獨使用效果有限，但結合抗阻訓練可能改善骨關節炎患者的肌肉量與生活品質；纖維肌痛試驗顯示肌力增加但疼痛效果不一致，提示需更精準試驗。

纖維肌痛症慢性疼痛營養補充運動治療系統性回顧

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低

Comment on: "A cluster analysis of psychological variables to identify profiles of Nociplastic pain: A cross-sectional study in women with fibromyalgia, chronic headache and vulvodynia" by Nimbi et al. are conflating the theory with the empirics.

Journal of psychosomatic research

未提供摘要，屬於學術評論，臨床價值有限。

纖維肌痛症心理治療臨床研究評論

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中

Assessing the Efficacy of Cannabinoid Compositions for Treating 3 Classes of Chronic Pain: A Real-World Evidence Study.

Clinical therapeutics

真實世界證據顯示不同大麻素組合（如CBD+THC、CBDa+CBG+CBC）對纖維肌痛、類風濕性關節炎、膝/髖骨關節炎均有助於改善疼痛、睡眠，但認知功能未見改善，部分組織對神經病理性疼痛特別有效。

纖維肌痛症慢性疼痛藥物治療大麻素真實世界證據

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中

Circadian rest-activity rhythm and sleep in women with fibromyalgia and other central sensitization syndromes.

Journal of psychosomatic research

纖維肌痛患者日間活動節律較弱且節律碎片化（高IV），與疲嚴重相關；其他中樞敏感症則表現為夜間活動增加與睡眠維持困難，提示需分 Syndrome 管理。

纖維肌痛症慢性疼痛睡眠醫學中樞敏感化節律生物學

🦠

中

Central sensitization in long COVID: Associations with autonomic symptom burden, cerebral hypoperfusion, and neuroinflammation.

Journal of the neurological sciences

長COVID患者中樞敏感化盛行（81%），與自律神經負荷、腦灌流減少及IL-6升高相關，提示纖維肌痛機制可能在其他慢性病中重現。

慢性疼痛中樞敏感化長COVID自律神經神經科學

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中

Depression, pain, and functional impairment across fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus: A cross-condition analysis and mediation model.

Journal of psychosomatic research

纖維肌痛在抑鬱、疼痛、中樞敏感化與功能障礙方面顯著較其他風濕病嚴重，疼痛在抑鬱與功能障礙間具有部分中介效應，支持一體化治療。

纖維肌痛症慢性疼痛憂鬱症中樞敏感化功能障礙

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中

Meta-Analysis: Chronic Gastrointestinal Symptoms and Comorbidities in Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders.

Alimentary pharmacology & therapeutics

過度活動型Ehlers-Danlos症候群患者慢性胃腸症狀患病率高（OR 4.29），併發纖維肌痛風險亦增加（OR 27.9%），提示腸道機能障礙可能是共享病理基礎。

纖維肌痛症慢性疼痛腸道疾病併發症系統性回顧

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中

Non-invasive electrochemical detection of cortisol in artificial sweat using molecularly imprinted polymer.

Talanta

開發出人工汗液中選擇性偵測皮質醇的分子印聚電極，線性範圍寬（100 pg/mL–160 ng/mL），適合纖維肌痛等壓力相關疾病的非侵入式生物標記監測。

纖維肌痛症慢性疼痛生物標記感測器壓力

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中

Fibromyalgia as a Risk Factor for Postoperative Complications Following Total Knee Arthroplasty.

The journal of knee surgery

經年齡、性別、種族、保險、共病、阿片使用等因素匹配後，纖維肌痛患者進行全膝關節置換術後仍有較高併發症風險（如腸梗阻OR 1.95、意識混亂OR 1.30），提醒手術前需評估。

纖維肌痛症慢性疼痛手術風險併發症退行性關節炎

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低

Wearable Devices for Bioelectrical Stimulation in Rehabilitation: Review of the Current State.

American journal of physical medicine & rehabilitation

可穿戴生物電刺激設備在纖維肌痛康復中的應用證據有限，目前僅作為傳統復健的輔助手段，需更多高品質試驗。

纖維肌痛症慢性疼痛復健治療物理治療穿戴設備

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中

"This is how we should work" - healthcare professionals' past uncertainty and present confidence in management of fibromyalgia.

International journal of qualitative studies on health and well-being

透過敘事研究發現醫療團隊對纖維肌痛自管理計畫的信心來自共享臨床心智模式（mindline）、跨專業合作與反思實踐，強調團隊協同的重要性。

纖維肌痛症慢性疼痛心理治療自我管理醫師培訓

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低

Treatment trajectories among patients with musculoskeletal disorders in Norway - a register-based cohort study over 2 years.

Scandinavian journal of primary health care

挪威肌肉骨骼疾病患者約75%為低醫療使用者，纖維肌痛組模式類似；高教育與本國出生者較易降低使用，提示社會因素影響醫療行為。

纖維肌痛症慢性疼痛醫療資源 utilisation流行病學社會心理

Chronic Pain · 纖維肌痛症與慢性疼痛文獻日報

Catecholamine-mediated release of miR-133a-3p from adipocytes regulates the onset of chronic primary pain.

Preliminary Investigation of Disorders of Gut-Brain Interaction and Their Associations With Psychological Flexibility and Daily Functioning in People With Fibromyalgia.

Effectiveness of a 6-Month Land-Based and Water-Based Exercise Intervention on Body Composition and Physical Fitness in Women With Fibromyalgia: The Al-&#xc1;ndalus Quasi-experimental Study.

The effects of neuromodulation through brainwave entrainment on pain in women with fibromyalgia: a randomized controlled clinical trial with follow-up.

Prevalence of Attention Deficit Hyperactivity Disorder in Adult Patients With Fibromyalgia.

IgG Glycosylation Patterns May Identify Distinct Clinical Trajectories in Fibromyalgia Patients: A Longitudinal Pilot Study.

Assessment of the 2D:4D Digit Ratio in Women With Fibromyalgia: Traces of Prenatal Hormonal Exposure.

Alexithymia moderates brain function during suppression of negative emotions in fibromyalgia.

Prevalence and clinical factors associated with difficult-to-manage axial spondyloarthritis: a multicentre Italian cohort study with meta-analysis.

Hypermobile Ehlers-Danlos Syndrome and Widespread Pain: Beyond Structural Laxity.

Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society.

Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society.

Clinical impact of nociplastic symptom burden in individuals with fibromyalgia syndrome.

Comment on "Abnormal Resting-State Functional Connectivity Between the Dorsal Anterior Cingulate Cortex and the Limbic System Contributes to Pain and Emotion Regulation Impairment in Fibromyalgia Patients".

Associations between osteoarthritis and comorbidities before and after diagnosis across four European primary care databases: a multinational case-control and cohort study.

A scoping review on the characteristics of chronic pain registries.

Does maladaptive microvascular flow redistribution cause tissue hypoxia in fibromyalgia?

Effects of N-methyl-d-aspartate receptor modulation on brain glutamate, functional connectivity, and clinical symptoms in fibromyalgia.

The role of the kynurenine pathway in the pathogenesis of pain and affective disorders after traumatic brain injury.

Longitudinal stability of data-driven fibromyalgia phenotypes across repeated clinical assessments.

Perceptions of Fibromyalgia Across Career Stages: Survey Results From Internal Medicine Physicians and Medical Students.

Targeting TRPA1 antagonists for nociplastic pain: systematic review and meta-analysis of preclinical evidence.

Fibromyalgia: a real phantom pain?

Antihyperalgesic and antiallodynic effects of Salvia rosmarinus Spenn. extracts and some of their bioactive metabolites in a murine fibromyalgia pain model.

Integrative Analysis of Hub Genes and miRNAs Reveals Inflammatory and Structural Signatures in Fibromyalgia and Their Modulation Following Manual Therapy.

Fibromyalgia in patients with idiopathic inflammatory myopathies: prevalence, associated factors, and relationship with patient outcomes and health care utilization.

Impact of creatine supplementation alone or combined with exercise on inflammatory and clinical outcomes in chronic musculoskeletal pain treated in the rheumatological field: a systematic review.

Comment on: "A cluster analysis of psychological variables to identify profiles of Nociplastic pain: A cross-sectional study in women with fibromyalgia, chronic headache and vulvodynia" by Nimbi et al. are conflating the theory with the empirics.

Assessing the Efficacy of Cannabinoid Compositions for Treating 3 Classes of Chronic Pain: A Real-World Evidence Study.

Circadian rest-activity rhythm and sleep in women with fibromyalgia and other central sensitization syndromes.

Central sensitization in long COVID: Associations with autonomic symptom burden, cerebral hypoperfusion, and neuroinflammation.

Depression, pain, and functional impairment across fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus: A cross-condition analysis and mediation model.

Meta-Analysis: Chronic Gastrointestinal Symptoms and Comorbidities in Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders.

Non-invasive electrochemical detection of cortisol in artificial sweat using molecularly imprinted polymer.

Fibromyalgia as a Risk Factor for Postoperative Complications Following Total Knee Arthroplasty.

Wearable Devices for Bioelectrical Stimulation in Rehabilitation: Review of the Current State.

"This is how we should work" - healthcare professionals' past uncertainty and present confidence in management of fibromyalgia.

Treatment trajectories among patients with musculoskeletal disorders in Norway - a register-based cohort study over 2 years.

Effectiveness of a 6-Month Land-Based and Water-Based Exercise Intervention on Body Composition and Physical Fitness in Women With Fibromyalgia: The Al-Ándalus Quasi-experimental Study.