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The aim of this study was to clarify different pathophysiological characteristics between subgroups of patients with fibromyalgia. We identified subgroups with distinct pain thresholds: those with a low pressure pain threshold (PL; 16 patients) and those with a normal pressure pain threshold (PN; 15 patients). Both groups experienced severe pain. We performed resting-state functional MRI analysis and detected 11 functional connectivity pairs among all 164 ROIs with distinct difference between the two groups (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The most distinctive one was that the PN group had significantly higher functional connectivity between the secondary somatosensory area and the dorsal attention network (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Then, we investigated the transmission pathway of pain stimuli. Functional connectivity of the thalamus to the insular cortex was significantly higher in the PL group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01\u2009\u2013\u20090.05). These results suggest that endogenous pain driven by top-down signals via the dorsal attention network may contribute to pain sensation in a subgroup of fibromyalgia patients with a normal pain threshold. Besides, external pain driven by bottom-up signals via the spinothalamic tract may contribute to pain sensations in another group of patients with a low pain threshold. <\/jats:p><jats:p>Trial registration: UMIN000037712.<\/jats:p>","DOI":"10.1038\/s41598-024-60993-9","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T11:01:59Z","timestamp":1714734119000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Functional connectivity associated with attention networks differs among subgroups of fibromyalgia patients: an observational case\u2013control study"],"prefix":"10.1038","volume":"14","author":[{"given":"Tomohiko","family":"Aoe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoko","family":"Kawanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumio","family":"Ohsone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Hara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tokuzo","family":"Yokokawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"60993_CR1","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1002\/acr.20140","volume":"62","author":"F Wolfe","year":"2010","unstructured":"Wolfe, F. et al. 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