Fibromyalgia as a trauma-related functional syndrome: multimodal neurobiological basis, post-traumatic model, and interoceptive-emotional reprocessing

Fibromyalgia (FM) is a heterogeneous condition that, in a substantial proportion of patients, resists a purely organic explanation. Following previous articles dedicated to diagnostic paradoxes, this work aims to develop a post-traumatic and functional therapeutic model. The central hypothesis is that, after excluding unrecognized organic conditions—primarily small fiber neuropathy, documented in approximately 40–50% of patients (Grayston et al., 2019; Marshall et al., 2025; Oaklander et al., 2013)—the residual core of what we call "fibromyalgia" may represent, in a significant portion of cases, the somatic expression of a trauma-related disorder or a post-traumatic spectrum. PTSD prevalence estimates in FM vary widely depending on samples and diagnostic criteria, from about 9% in large-scale retrospective studies up to over 70% in clinical samples selected for trauma (Gardoki-Souto et al., 2022; Rahangdale & Ferraro, 2025), but the direction of the association is constant. A 2025 review proposes that FM and PTSD share a common pathogenetic mechanism—salience network hyperactivity—and should be read as parts of the same spectrum (Luís et al., 2025). Early trauma would remain encoded in implicit memory, in limbic (amygdala) and interoceptive (right anterior insula) circuits, without sufficient integration with hippocampal and prefrontal circuits that allow contextualization and narration. This integration deficit produces a self-reinforcing circuit—metaphorically the "broken record," technically a self-sustained maladaptive attractor state—and finds correspondence in specific patterns documented by MRI, fMRI, EEG/MEG, and EMG. On this basis, the article presents an exploratory proposal for therapeutic integration combining targeted EMDR (validated technique) with Harmony Meditation and Analogic Meditation (meditative practices developed by the author, not yet validated by independent trials), discusses available evidence on meditation for chronic pain and central sensitization, and introduces the concept of the Incredulity Effect as an original construct—here proposed as an interpretative hypothesis—that can psychologically hinder remission.