Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia, Margarida Pinto et al 2022

[Jaybee00]

https://www.nature.com/articles/s41584-022-00873-6

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive ‘threat’ system and underactive ‘soothing’ system, might keep the ‘salience network’ (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.

 

[Jaybee00]

 

[Trish]

I only have access to the abstract and that twitter thread, so I may have completely misunderstood this hypothesis. I would like to understand whether this is any different from central sensitisation, or the stress/ HPA axis hypotheses.

 

[rvallee]

It's the same crap about fear and emotions. It's presented as novel every single time. None of this junk will matter in the end. What does it even say about people who keep presenting the exact same idea over and over again who pretend it's all new? Do they not know? Not care? Can't tell the difference? What? How?!

How of all things it's medicine, the profession that deals with life and death, that still believes in angels and fairies stuff?!

 

[rvallee]

this article focuses on an hypothesis

Not even a hypothesis, it's a model, random speculation. It's the same model as always. A hypothesis is testable, there is nothing to test here, this is just a bunch of the same old narratives, zero science involved.

Seeing actual physicians with LC gush over this stuff explains a lot about why things are so broken. This stuff is basically magic, it tickles our fancy about supernatural powers and is so damn dangerous because people just can't resist it.

 

[shak8]

Fibromyalgia: Genetics and epigenetics insights may provide the basis for the development of diagnostic biomarkers - Simona D’Agnelli, Lars Arendt-Nielsen, Maria C Gerra, Katia Zatorri, Lorenzo Boggiani, Marco Baciarello, Elena Bignami, 2019 (sagepub.com)

This was one article in the references of the above mentioned research article that was interesting to me as a PwFM. This shows the complexity of the illness

 

[Sean]

Not even wrong.

Shame on you, Nature.

 

[Charles B.]

At what point does this hypothesis, which is essentially a variation on general BPS theorizing, need to produce concrete evidence? It seems to always be in a provisional state, while simultaneously being widely acclaimed as sacrosanct. I wouldn’t believe medicine was this primitive if it weren’t happening to me, and that underscores the broader problem.

 

[Hutan]

Shame on you, Nature.

Indeed. 'Nature Reviews Rheumatology' - Perspectives

Nature Reviews' basic, translational and clinical content is written by internationally renowned basic and clinical academics and researchers and targeted towards readers in the biological and medical sciences, from postgraduate level upwards. While intended to be read by practicing doctors, researchers and academics within a specialty, we aim to make all our articles accessible to readers working in any biological or medical discipline.

...Topical discussion and opinions are proffered in Perspectives, Comment and News & Views articles, and in the Research Highlights section we filter primary research from a range of specialty and general medical and scientific journals.

It's ugly stuff, and very upfront about it. They conjecture that people with fibromyalgia are hysterical with their imbalanced emotional regulation system, and then call their model the FITSS model. (As in 'she's just having a bit of a hysterical fit'). It's at the same puerile level as those researchers in Sydney, part of Lloyd's team, who advertised for participants in a study with a poster saying 'Are women with CFS ovary-reacting?'. I don't understand how no one says 'umm, maybe this isn't a great idea?'.

We propose that an imbalance in emotion regulation, reflected by an overactive ‘threat’ system and underactive ‘soothing’ system, might keep the ‘salience network’ (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model.

I'm going to list the authors and some of their affiliations because I think vague unevidenced witterings like this are pretty close to being hate speech. They certainly cause harm and they should not be honoured with being published in Nature Review. I find the international reach of the people who are happy to put their name to this stuff concerning. (Sorry, there are a lot of authors and even more affiliations... )

Ana Margarida Pinto
University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Coimbra, Portugal
University of Coimbra University Clinic of Rheumatology, Faculty of Medicine, Coimbra, Portugal
University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Coimbra, Portugal

Rinie Geenen
Altrecht Psychosomatic Medicine Eikenboom, Zeist, The Netherlands

Tor D. Wager
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA

Mark A. Lumley
Department of Psychology, Wayne State University, Detroit, MI, USA

Winfried Häuser
Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany

Eva Kosek
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

Jacob N. Ablin,
Internal Medicine H, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel: Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel

Kirstine Amris,
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark

Jaime Branco
Rheumatology Department, Egas Moniz Hospital — Lisboa Ocidental Hospital Centre (CHLO-EPE), Lisbon, Portugal
Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Lisbon, Portugal

Dan Buskila
Ben Gurion University of the Negev Beer-Sheba, Beersheba, Israel

João Castelhano

Miguel Castelo-Branco,

Leslie J. Crofford,

Mary-Ann Fitzcharles,
Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada

Marina López-Solà,
Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

Mariana Luís,
Tiago Reis Marques,
Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, London, UK
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Philip J. Mease,
Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA
University of Washington School of Medicine, Seattle, WA, USA

Filipe Palavra,
Centre for Child Development, Neuropediatric Unit, Paediatric Hospital, Coimbra Hospital and University Centre, Coimbra, Portugal

Jamie L. Rhudy,

Lucina Q. Uddin,
Department of Psychology, University of Miami, Coral Gables, FL, USA

Paula Castilho,

Johannes W. G. Jacobs
Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands

José A. P. da Silva
University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Coimbra, Portugal
Rheumatology Department, Coimbra Hospital and University Centre, Coimbra, Portugal

 

[Hutan]

At what point does this hypothesis, which is essentially a variation on general BPS theorizing, need to produce concrete evidence? It seems to always be in a provisional state, while simultaneously being widely acclaimed as sacrosanct. I wouldn’t believe medicine was this primitive if it weren’t happening to me, and that underscores the broader problem.

 

[shak8]

I looked on Pubmed for any research using: salient network and fibromyalgia and zero results.

I looked up salient network and found this entry on ScienceDirect. It is concerned with Parkinson's Disease (PD).
From the textbook:
Cognition in Parkinson's Disease
James F. Cavanagh, ... Sarah Pirio Richardson, in Progress in Brain Research, 2022


"The salience network is primarily involved with orienting to surprising events, particularly if they demand the exertion of control. The orienting response is thought to act as an alarm bell of the need for cognitive control, helping to trigger the cascade of brain processes involved in adjusting to new demands (Fan, 2014; Wessel, 2018). The orienting response to novel stimuli is particularly compromised in PD (Kingstone et al., 2002; Poliakoff et al., 2003; Yamaguchi and Kobayashi, 1998; Zhou et al., 2012). An altered orienting response directly affects quality of life issues in patients by leading to distractibility (Sharpe, 1990)..."

 

[rvallee]

At what point does this hypothesis, which is essentially a variation on general BPS theorizing, need to produce concrete evidence? It seems to always be in a provisional state, while simultaneously being widely acclaimed as sacrosanct. I wouldn’t believe medicine was this primitive if it weren’t happening to me, and that underscores the broader problem.

It's pretty clear by now that no evidence is needed here. Evidence against even seems to reinforce beliefs, makes people dig their heels further. Which firmly makes it a belief system, and you can't reason with beliefs, especially when they've been tradition for this long. Acknowledging reality means acknowledging that millions of lives were bet on the dumbest what if imaginable.

I don't know how we can fight that, bad ideas are the hardest thing to beat back, and then you add the inability to take responsibility for anything. It frankly seems like belief is growing with time, and medicine is on the verge of abandoning science because of it. They seem to think they're covered the science part, the rest is all hippy BS, except somehow far worse.

 

[Sean]

I don't know how we can fight that, bad ideas are the hardest thing to beat back,

Remember the saying that you can't stop an idea whose time has come?

Note that the saying doesn't mention anything about it being a good or bad idea.

Bad ideas can be just as, if not more, resistant to being modified or abandoned.

 

[shak8]

Because I was socialized into the field of healthcare, I tend to give researchers more benefit of the doubt than they deserve. And, I cannot do a peer review; I don't have the knowledge.

Yet, on Science4me, most of the FM research articles posted are psychology departments who have their idiosyncratic take on hard science (salience network--self-soothing).

They fluff it up to make their career-enhancing hypotheses in publications look rational and important.

One thing is missing from the vast majority of FM research: the fact that the pain and other symptoms persist, hour after hour, day after day. Year after year.

So blame the person with FM for...having FM and continuing to have FM, despite the fact that researchers say there is no effective treatment. No effective treatment at this point in time.

How much mindful self-soothing can one do in a day, 16 hours worth?

*Effective treatment consists primarily of a 60% reduction in pain in the majority of patients with tolerable and safe side effects.

 

[Andy]

Hypothetical model ignores many important pathophysiologic mechanisms in fibromyalgia, 2023, Clauw et al

"We would like to respond to the Perspective article by Pinto et al. (Pinto, A. M. et al. Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia. Nat. Rev. Rheumatol. 19, 44–60 (2023))1. We feel that the proposed model severely overfits the complicated pathophysiology of fibromyalgia and is not applicable to all or even most individuals with this condition. We are concerned that this theory could inadvertently drive the field backwards despite several decades of research that has begun to illuminate neurobiological mechanisms underlying fibromyalgia and other chronic pain conditions. Our main points are outlined here.

First and foremost, we disagree that psychological stress is the sole cause of fibromyalgia. It is inappropriate and invalidating to imply this is the predominant causal mechanism in fibromyalgia. Many individuals with fibromyalgia do not have a history of trauma, psychiatric comorbidity or even extraordinary stress. Thus, these individuals will not benefit from and may be harmed by this inaccurate and potentially stigmatizing conceptualization of fibromyalgia."

Open access, https://www.nature.com/articles/s41584-023-00951-3

 

[Andy]

Reply to: Hypothetical model ignores many important pathophysiologic mechanisms in fibromyalgia, 2023, Pinto et al

"In sum, we do not disagree with the substantive points in the correspondence from Clauw et al.1, but we do disagree with how our paper2 is summarized. We primarily aimed for a balanced paper and so invited the critical contribution of many authors with potentially different views. Consensus is often difficult to achieve, but we believe that engaging different views can both establish common ground and reveal areas where more scientific evidence is needed to resolve ambiguity. We are grateful that the paper, and this correspondence, enables us to further that goal."

Open access, https://www.nature.com/articles/s41584-023-00952-2

 

[shak8]

Glad that a well-known and respected FM researcher/MD of U of Michigan, Daniel Clauw, wrote this rebuttal.

I hope he and his group will continue to counter the onslaught of "anxiety, depression, stress, adverse childhood events" trope posed in research articles as causes of FM.