Volumetric MRI Analysis of the Brain Pain Matrix in Fibromyalgia: Unraveling the Structural Changes and Neural Mechanisms of Chronic Pain

Objective Fibromyalgia (FM) is a chronic pain syndrome predominantly affecting women, characterized by widespread pain, sensory hypersensitivity, fatigue, and sleep disturbances. Recent evidence suggests that chronic pain in FM is closely associated with dysfunctions in the central nervous system (CNS). This study aims to identify volumetric brain changes observed in FM patients and to evaluate the relationship between these structural alterations and neural plasticity mechanisms. Methods The study included 32 female patients diagnosed with FM (aged 22–79 years; mean age: 44.72 ± 12.63) and 31 age- and sex-matched healthy controls (aged 24–56 years; mean age: 37.87 ± 8.29). There was no significant age difference between the groups (p = 0.102). High-resolution T1-weighted magnetic resonance imaging (MRI) data were analyzed using the vol2Brain module of the volBrain platform. Volumetric measurements were obtained for 135 distinct brain regions. Results Volumetric analyses revealed marked changes in the limbic system structures of FM patients. Increased volumes were observed in the thalamus, amygdala, and hippocampus, whereas the anterior and medial cingulate gyri and insular cortex exhibited decreased volumes. Additional findings included an increase in total white matter (WM) and subcortical gray matter, along with a reduction in cerebellar WM volume. Conclusion The results underscore the neurobiological basis of FM and suggest that the observed structural changes are linked to neural plasticity mechanisms within the CNS. Identifying FM-specific volumetric alterations may support the development of personalized and targeted therapeutic interventions.