The role of sleep and attention in the etiology and maintenance of fibromyalgia

Fibromyalgia (FM) is a prevalent, debilitating condition characterized by widespread, intense pain experienced as emanating from in the muscles, tendons, and ligaments. Other symptoms include disabling fatigue, poor sleep quality, gastrointestinal complaints, cognitive difficulties and often depression. Lack of apparent muscle pathology or other obvious physiological causes of FM pain make the etiology of FM unclear. This manuscript reviews extant FM literature and integrates research on sleep and the burgeoning literature from the domain of cognitive neuroscience to formulate the Sleep and Pain Diatheses (SAPD) model of FM. This model proposes that a wide range of biopsychosocial stressors can set the stage for FM by activating diatheses for sleep disruption and pain sensitivity. Sleep disruption in those most sensitive to pain initiates a cascade of symptoms that are codified as FM. Once this process is initiated, the symptoms of FM are perpetuated and aggravated by increased vigilance to a broad range of threat-related biopsychosocial stimuli. Thus, it is proposed that sleep is integral to the etiology of FM and also energizes a cognitive feedback loop that maintains or amplifies symptom severity over time.