Fibromyalgia and the Brain: A New Model of the Painful Self

Fibromyalgia is a chronic condition that changes how the body processes pain. It causes widespread musculoskeletal pain, fatigue, non-restorative sleep, cognitive problems (“fibro fog”), and emotional distress. There’s no single cause or cure, but brain imaging studies are giving new insight into why symptoms persist.

A 2025 meta-analysis by Cavicchioli and colleagues looked at how brain connectivity might explain the ongoing pain and fatigue in fibromyalgia. The authors combined two established brain models — the nested hierarchical model of self and the pain matrix — to explore how self-awareness and pain processing interact.

The two brain models

• Nested hierarchical model of self

  • Interoceptive self: awareness of internal sensations like heartbeat, pain, and gut tension

  • Exteroceptive/proprioceptive self: awareness of body position and interaction with the environment

  • Mental self: thoughts, memories, and identity

• Pain matrix

  • Network of brain areas involved in detecting, modulating, and interpreting pain, including the thalamus, somatosensory cortices, insula, anterior cingulate cortex (ACC), and periaqueductal gray (PAG)

By combining these, the researchers looked at fibromyalgia as both a sensory processing disorder and a condition involving self-related brain activity.

How the study was done
They analysed 11 resting-state fMRI studies comparing people with fibromyalgia to healthy controls. Resting-state imaging shows how brain regions communicate when a person is not doing a task — a way to study baseline brain network activity. The team examined:

• Connections within and between self-related brain regions

• Connections within the pain matrix

• Links between brain connectivity patterns and pain intensity

Key findings

1. More connectivity between self-related regions
   People with fibromyalgia showed stronger communication between the default mode network (DMN) — part of the “mental self” — and areas involved in body awareness (insula, ACC, sensory cortices). This suggests greater internal focus and sensitivity to body signals, even at rest.

2. Less connectivity in the pain matrix
   The PAG, important for pain inhibition, was less connected to somatosensory areas. This may reflect a reduced ability to dampen pain signals.

3. Self-related connectivity linked to pain
   Stronger DMN–insula connections were associated with higher pain reports. This suggests that when body awareness is closely tied to self-processing, pain may feel more persistent and personal.

Why it matters
These findings support the idea that fibromyalgia involves both altered pain signalling and changes in how the brain integrates that pain into a person’s sense of self. This could help explain why symptoms often feel constant and why mood changes, dissociation, or identity-related distress can occur alongside physical symptoms.

Implications for treatment
Targeting brain networks linked to both self-processing and pain regulation may help. Options include:

• Mindfulness-based interventions — reduce hypervigilance to bodily sensations and change DMN–insula connectivity

• Acceptance and Commitment Therapy (ACT) — helps separate the experience of pain from self-identity

• Movement-based therapies — from aerobic exercise to gentle resistance training and somatic movement, supporting body awareness and pain modulation

• Breathwork and meditation — can influence interoception and autonomic regulation

These are not distraction techniques; they aim to gradually reorganise brain networks that shape pain, awareness, and self-perception.

Reference
Cavicchioli, M., Scalabrini, A., Nimbi, F., et al. (2025). Fibromyalgia and the painful self: A meta-analysis of resting-state fMRI data. Journal of Psychiatric Research, 183, 61–71. https://doi.org/10.1016/j.jpsychires.2025.01.048