![]() The fibromyalgia syndrome (FMS) is a chronic pain disorder with a prevalence of approximately 2% in the general population 1. We propose considering these subgroups when conducting clinical trials. Our results suggest that the subgroup of fibromyalgia patients with pronounced pathology in the peripheral nervous system shows alterations in morphology, structural and functional connectivity also at the level of the encephalon. The subgroup with reduced skin innervation showed hyperconnectivity between the inferior frontal gyrus, the angular gyrus and the posterior parietal gyrus. Using resting-state fMRI, the fibromyalgia group as a whole showed functional hypoconnectivity between the right midfrontal gyrus and the posterior cerebellum and the right crus cerebellum, respectively. Diffusion tensor imaging revealed a significant increase in fractional anisotropy in the corona radiata, the corpus callosum, cingulum and fornix in patients with fibromyalgia compared to healthy controls and decreased FA in parts of the internal capsule and thalamic radiation in the subgroup with reduced skin innervation. Compared to controls, cortical thickness was decreased in regions of the frontal, temporal and parietal cortex in the fibromyalgia group as a whole, and decreased in the bilateral pericalcarine cortices in the fibromyalgia subgroup with reduced skin innervation. Brains were analysed for cortical volume, for white matter integrity, and for functional connectivity. We further compared the fibromyalgia subgroups with reduced (n = 21) and normal (n = 22) skin innervation. ![]() This prospective case–control study included 43 women diagnosed with fibromyalgia syndrome and 40 healthy controls. We tested the hypothesis that reduced skin innervation in fibromyalgia syndrome is associated with specific CNS changes.
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