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. 2023 Apr 6;10:952278. doi: 10.3389/fmed.2023.952278

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Copyright © 2023 Plaut.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Overlaps of fibromyalgia-related and myofascial pain syndromes [adapted for long COVID-19 from Figure 7 in Plaut (2022) (4)]. Not all relationships and overlaps are depicted in this scheme. The colors have no special meaning. Variation in manifestation depends, in part, on the anatomical area and severity of involvement of the bio-tensegrity structure, and the downstream consequences of myofibroblast-generated-tensegrity-tension and fascial stiffness. If local fascial armoring becomes widespread, it will manifest as a fibromyalgia-like condition, depending on anatomical location, severity, and the layers involved, as well as additional soft tissue and visceral organ involvement. Psychological, metabolic, immune, endocrine, autonomic, behavioral, and other factors also contribute to variation in manifestation. The term “Healthy” is open to interpretation. “Nonspecific low back pain” reflects fascial armoring and imbalanced tensegrity forces in the lower back. “Nonspecific neck pain” reflects imbalance affecting the neck. “Primary headache disorders” i.e., imbalance in the head. “Irritable bowel syndrome” reflects fascial armoring and compressive forces in the lower back and abdomen (which might affect peristalsis and gut microbiome bidirectionally). “Myofascial pelvic pain syndrome” (including “interstitial cystitis”)-fascial armoring and fascial stiffness/pressure in the pelvic fascia, etc. If fascial armoring becomes more widespread, it can be expressed as somatic symptom disorder or fibromyalgia-like conditions. Long COVID-19 is included here in cases when this post infectious syndrome manifests as a fibromyalgia-like syndrome, with no clear pathology found, normal investigations and imaging and laboratory tests, and with marked discrepancy between patient complaints and clinical findings. CWP, chronic widespread pain; ME/CFS, myalgic encephalomyelitis/chronic fatigue syndrome; MPS, myofascial pain syndrome; SSD, somatic symptom disorder. Multiplying entities when there really is only one is not beneficial for science.