2026 — Dysautonomia prevalence in chronic musculoskeletal pain (meta-analysis)
One-paragraph summary
Systematic review and meta-analysis of 17 studies (MEDLINE + Embase through 2024-10-04) estimating the prevalence of autonomic dysfunction in chronic musculoskeletal pain conditions, including FM. Risk of bias assessed via adapted Newcastle-Ottawa Scale; prevalence and relative-risk estimated via random-effects meta-analysis. For the project, this paper provides the most rigorous population-prevalence estimate to date for dysautonomia in FM and related chronic musculoskeletal pain conditions — directly relevant to the long-standing Q29 (vagal-autonomic-dominant fifth FM subtype hypothesis) and to the biomarker-mapping cohort's autonomic-axis dimensions (HRV, COMPASS-31).
Claims as triples
autonomic_dysregulation — present_in → fm_central_only[evidence: 17-study systematic review + meta-analysis; confidence: emerging (upgraded from existing established edge)]autonomic_dysregulation — correlates_with → widespread_pain[evidence: prevalence-and-relative-risk analysis across chronic musculoskeletal pain conditions; confidence: emerging]
Triangulation notes
- Provides the prevalence anchor for Q29 (vagal-autonomic-dominant FM subtype) that the project has been carrying as an open question since v0.1.
- Adds discipline to the biomarker-mapping cohort design — autonomic measures (HRV, COMPASS-31) should be sized per the prevalence estimates this meta-analysis provides.
- Reinforces the HαT/TPSAB1 → dysautonomia connection (Lyons 2019 cohort showed POTS / orthostatic intolerance prominently in HαT-positive patients).
- Discovered via Probe 5 (EDS/hypermobility); scored ingestion-worthy; promoted in Recommendation 3.